1184878449 NPI number — ADVANCED BEHAVIORAL COUNSELING OF NORTHERN NEW JERSEY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184878449 NPI number — ADVANCED BEHAVIORAL COUNSELING OF NORTHERN NEW JERSEY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED BEHAVIORAL COUNSELING OF NORTHERN NEW JERSEY LLC
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:
1184878449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 NEWTON SPARTA RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07860-2772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-579-9394
Provider Business Mailing Address Fax Number:
973-579-9392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 NEWTON-SPARTA ROAD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07860-2056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-579-9394
Provider Business Practice Location Address Fax Number:
973-579-9392
Provider Enumeration Date:
11/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DRUMM
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PSYCHIATRIC NURSE PRACTITIONER
Authorized Official Telephone Number:
973-579-9394

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  26NN0047373 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0809X , with the licence number: 26NN004737300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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