Provider Demographics
NPI:1346778933
Name:GREEN MEADOWS THERAPY CENTER
Entity Type:Organization
Organization Name:GREEN MEADOWS THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARYEH
Authorized Official - Middle Name:
Authorized Official - Last Name:PETGORSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-272-0177
Mailing Address - Street 1:251 OAK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-8616
Mailing Address - Country:US
Mailing Address - Phone:732-503-6119
Mailing Address - Fax:
Practice Address - Street 1:251 OAK GLEN RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-8616
Practice Address - Country:US
Practice Address - Phone:732-272-0177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty