Provider Demographics
NPI:1366137937
Name:D20 THERAPEUTICS
Entity type:Organization
Organization Name:D20 THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:MAITRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-516-6282
Mailing Address - Street 1:154 BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5725
Mailing Address - Country:US
Mailing Address - Phone:408-516-6282
Mailing Address - Fax:
Practice Address - Street 1:92 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2713
Practice Address - Country:US
Practice Address - Phone:862-621-9175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033609847OtherNPPES