1134623416 NPI number — PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY, INC

Table of content: (NPI 1134623416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134623416 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:
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:
1134623416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-8036
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:
40 CHRISTOPHER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATONTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07724-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-663-1800
Provider Business Practice Location Address Fax Number:
732-663-1698
Provider Enumeration Date:
03/21/2018

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 2000648 , 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: 2000648 . This is a "STATE LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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