1114671559 NPI number — OUTPATIENT BEHAVIORAL HEALTH SERVICES OF NEW JERSEY, P.C.

Table of content: (NPI 1114671559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114671559 NPI number — OUTPATIENT BEHAVIORAL HEALTH SERVICES OF NEW JERSEY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTPATIENT BEHAVIORAL HEALTH SERVICES OF NEW JERSEY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114671559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 63018
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07101-8064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-515-3834
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 OVERLOOK CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-7814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-515-3834
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DURLOFSKY
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
888-515-3834

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)