1396912044 NPI number — INSTITUTE FOR PSYCHOLOGICAL AND SPIRITUAL GROWTH INC

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 1396912044 NPI number — INSTITUTE FOR PSYCHOLOGICAL AND SPIRITUAL GROWTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE FOR PSYCHOLOGICAL AND SPIRITUAL GROWTH INC
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:
1396912044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BETHANY RD
Provider Second Line Business Mailing Address:
SUITE34
Provider Business Mailing Address City Name:
HAZLET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07730-1663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-739-4098
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BETHANY RD
Provider Second Line Business Practice Location Address:
SUITE34
Provider Business Practice Location Address City Name:
HAZLET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07730-1663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-739-4098
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DE BONIS
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
BARBARA
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
732-739-4098

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  44SC00022200 , 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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