Provider Demographics
NPI:1376093880
Name:INTERNAL AFFAIRS TREATMENT GROUP
Entity Type:Organization
Organization Name:INTERNAL AFFAIRS TREATMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-422-5340
Mailing Address - Street 1:210 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-1306
Mailing Address - Country:US
Mailing Address - Phone:908-422-5340
Mailing Address - Fax:
Practice Address - Street 1:198 NORTH AVE E
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2469
Practice Address - Country:US
Practice Address - Phone:908-422-5340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COBAR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055329001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty