Provider Demographics
NPI:1235568098
Name:MEDALLION BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:MEDALLION BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMEBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHLOMO
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENZWEIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-600-6424
Mailing Address - Street 1:470 COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1624
Mailing Address - Country:US
Mailing Address - Phone:732-600-6424
Mailing Address - Fax:
Practice Address - Street 1:470 COLFAX AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1624
Practice Address - Country:US
Practice Address - Phone:732-600-6424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)