Provider Demographics
NPI:1326214149
Name:NORTH JERSEY BEHAVIORAL MEDICINE
Entity Type:Organization
Organization Name:NORTH JERSEY BEHAVIORAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT AND PEDIATRIC PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-669-2880
Mailing Address - Street 1:2 EXECUTIVE DR
Mailing Address - Street 2:SUITE 665
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 EXECUTIVE DR
Practice Address - Street 2:SUITE 665
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3308
Practice Address - Country:US
Practice Address - Phone:201-669-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00296100261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health