Provider Demographics
NPI:1780803452
Name:NORTH JERSEY BEHAVIORAL MEDICINE, LLC.
Entity type:Organization
Organization Name:NORTH JERSEY BEHAVIORAL MEDICINE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-669-2880
Mailing Address - Street 1:1225 RIVER RD
Mailing Address - Street 2:#8-D
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1459
Mailing Address - Country:US
Mailing Address - Phone:201-669-2880
Mailing Address - Fax:718-504-4122
Practice Address - Street 1:2 EXECUTIVE DR
Practice Address - Street 2:SUITE 665
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3308
Practice Address - Country:US
Practice Address - Phone:201-669-2880
Practice Address - Fax:718-504-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY63929Medicare UPIN
NJ358086Medicare UPIN
NJ87726Medicare UPIN
NJ63929Medicare UPIN