Provider Demographics
NPI:1033498803
Name:IMMEDIATE CARE PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:IMMEDIATE CARE PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-335-9909
Mailing Address - Street 1:28A HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1001
Mailing Address - Country:US
Mailing Address - Phone:973-335-9909
Mailing Address - Fax:973-335-9910
Practice Address - Street 1:28A HILL ROAD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1001
Practice Address - Country:US
Practice Address - Phone:973-335-9909
Practice Address - Fax:973-335-9910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMMEDIATE CARE PSYCHIATRIC CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ058035OtherMEDICARE GROUP PTAN