Provider Demographics
NPI:1538342787
Name:SUBURBAN THERAPY AND TREATMENT SERVICES LLC
Entity type:Organization
Organization Name:SUBURBAN THERAPY AND TREATMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:SHANJUN
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-740-2680
Mailing Address - Street 1:23907 OLD HUNDRED RD
Mailing Address - Street 2:
Mailing Address - City:DICKERSON
Mailing Address - State:MD
Mailing Address - Zip Code:20842-9666
Mailing Address - Country:US
Mailing Address - Phone:301-740-2680
Mailing Address - Fax:
Practice Address - Street 1:18502 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-0585
Practice Address - Country:US
Practice Address - Phone:301-740-2680
Practice Address - Fax:301-560-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01447Medicare PIN