1790842151 NPI number — PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY, INC.

Table of content: (NPI 1790842151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790842151 NPI number — PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY, 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:
BARNEGAT OFFICE
Provider Other Organization Name Type Code:
5
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:
1790842151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY
Provider Second Line Business Mailing Address:
P.O. BOX 2036
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-458-1700
Provider Business Mailing Address Fax Number:
732-785-3296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PREFERRED BEHAVIORAL HEALTH OF NJ OUT PATIENT SERVICES
Provider Second Line Business Practice Location Address:
848 WEST BAY AVE C - 1
Provider Business Practice Location Address City Name:
BARNEGAT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-660-0197
Provider Business Practice Location Address Fax Number:
609-660-0132
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VANORE
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CAO
Authorized Official Telephone Number:
732-458-1700

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  20302-11-04 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: DAS FACILITY #22924 , 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)

  • Identifier: 7506601 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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