Provider Demographics
NPI:1013409176
Name:GREENBROOK TMS NEWARK, LLC
Entity Type:Organization
Organization Name:GREENBROOK TMS NEWARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-801-1472
Mailing Address - Street 1:900 BESTGATE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3066
Mailing Address - Country:US
Mailing Address - Phone:301-801-1472
Mailing Address - Fax:
Practice Address - Street 1:121 BECKS WOODS DR STE 202
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3852
Practice Address - Country:US
Practice Address - Phone:855-755-4867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center