Provider Demographics
NPI:1316141484
Name:VOLL, MICHAEL V (RPN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:VOLL
Suffix:V
Gender:M
Credentials:RPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 OCEAN GATE AVE
Mailing Address - Street 2:PO BOX 1126
Mailing Address - City:OCEAN GATE
Mailing Address - State:NJ
Mailing Address - Zip Code:08037
Mailing Address - Country:US
Mailing Address - Phone:732-269-1827
Mailing Address - Fax:
Practice Address - Street 1:700 AIRPORT RD
Practice Address - Street 2:PREFERRED BEHAVIORAL HEALTH OF NJ
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5907
Practice Address - Country:US
Practice Address - Phone:732-367-4700
Practice Address - Fax:732-364-2253
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029807Medicaid