Provider Demographics
NPI:1053640797
Name:URBAN TREATMENT ASSOCIATES
Entity Type:Organization
Organization Name:URBAN TREATMENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOTTSCLAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-225-0505
Mailing Address - Street 1:808 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102
Mailing Address - Country:US
Mailing Address - Phone:856-225-0505
Mailing Address - Fax:856-541-0719
Practice Address - Street 1:808 MARKET STREET
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102
Practice Address - Country:US
Practice Address - Phone:856-225-0505
Practice Address - Fax:856-541-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X
NJ2000459-09261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8635200Medicaid