Provider Demographics
NPI:1346665007
Name:BURGESS PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:BURGESS PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:856-692-5600
Mailing Address - Street 1:629 E WOOD ST
Mailing Address - Street 2:SUITE 106-108
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-3730
Mailing Address - Country:US
Mailing Address - Phone:856-692-5600
Mailing Address - Fax:856-692-5601
Practice Address - Street 1:629 E WOOD ST
Practice Address - Street 2:SUITE 108
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-3730
Practice Address - Country:US
Practice Address - Phone:856-692-5600
Practice Address - Fax:856-692-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC04275400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health