Provider Demographics
NPI:1538364229
Name:BEHAVIORAL MEDICINE ASSOCIATES PA
Entity type:Organization
Organization Name:BEHAVIORAL MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-561-6851
Mailing Address - Street 1:1550 PARK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5565
Mailing Address - Country:US
Mailing Address - Phone:908-561-6851
Mailing Address - Fax:908-561-6863
Practice Address - Street 1:1550 PARK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5565
Practice Address - Country:US
Practice Address - Phone:908-561-6851
Practice Address - Fax:908-561-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA076750002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092259Medicare PIN
NJI27867Medicare UPIN