Provider Demographics
NPI:1093496861
Name:INTEGRATED PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:INTEGRATED PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:POGRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-858-5432
Mailing Address - Street 1:615 HOPE RD STE 5B
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1273
Mailing Address - Country:US
Mailing Address - Phone:732-858-5432
Mailing Address - Fax:
Practice Address - Street 1:615 HOPE RD STE 5B
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1273
Practice Address - Country:US
Practice Address - Phone:732-858-5432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty