Provider Demographics
NPI:1063020857
Name:POSITIVE IMPACT BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:POSITIVE IMPACT BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTINS
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHIBI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHIATRIC NP
Authorized Official - Phone:347-912-7566
Mailing Address - Street 1:178 NEWTON STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:17103-0710
Mailing Address - Country:US
Mailing Address - Phone:347-912-7566
Mailing Address - Fax:
Practice Address - Street 1:178 NEWTON STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-0710
Practice Address - Country:US
Practice Address - Phone:347-912-7566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty