Provider Demographics
NPI:1245609932
Name:UNION CHILD & ADOLESCENT PSYCHIATRY CENTER LLC
Entity Type:Organization
Organization Name:UNION CHILD & ADOLESCENT PSYCHIATRY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:INDIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-678-6319
Mailing Address - Street 1:40 PINEWOOD CRES
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 UPPER OVERLOOK ROAD
Practice Address - Street 2:210
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07910
Practice Address - Country:US
Practice Address - Phone:908-598-0390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08626200261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health