Provider Demographics
NPI:1033433834
Name:STRESS CARE OF NEW JERSEY, LLC
Entity Type:Organization
Organization Name:STRESS CARE OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SMUKLAVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:732-679-4500
Mailing Address - Street 1:PO BOX 612
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-0612
Mailing Address - Country:US
Mailing Address - Phone:732-679-4500
Mailing Address - Fax:732-679-4549
Practice Address - Street 1:4122 ROUTE 516
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-7031
Practice Address - Country:US
Practice Address - Phone:732-679-4500
Practice Address - Fax:732-679-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10174-02-04251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
314647Medicare PIN