Provider Demographics
NPI:1649718685
Name:MEDPSYCH ASSOCIATES OF NEW JERSEY LLC
Entity type:Organization
Organization Name:MEDPSYCH ASSOCIATES OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-995-1004
Mailing Address - Street 1:545 ISLAND RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2822
Mailing Address - Country:US
Mailing Address - Phone:201-995-1004
Mailing Address - Fax:201-345-7121
Practice Address - Street 1:545 ISLAND RD STE 2B
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2822
Practice Address - Country:US
Practice Address - Phone:201-995-1004
Practice Address - Fax:201-345-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty