1215216361 NPI number — BRIDGEWAY BEHAVIORAL HEALTH SERVICES

Table of content: DR. JEREMY CLASSO PHARMD (NPI 1093550170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215216361 NPI number — BRIDGEWAY BEHAVIORAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIDGEWAY BEHAVIORAL HEALTH SERVICES
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:
1215216361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
373 CLERMONT TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07083-8073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-355-7886
Provider Business Mailing Address Fax Number:
908-248-9376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 KING GEORGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORDS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08863-1974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-771-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JAN
Authorized Official First Name:
MOHSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING & REIMBURSEMENT
Authorized Official Telephone Number:
908-355-7886

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  204010248 , 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: 0266515 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".