Provider Demographics
NPI:1376698605
Name:INTEGRATED BEHAVIORAL CARE PA
Entity Type:Organization
Organization Name:INTEGRATED BEHAVIORAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:R
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-598-2400
Mailing Address - Street 1:35 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4604
Mailing Address - Country:US
Mailing Address - Phone:908-598-2400
Mailing Address - Fax:908-598-2408
Practice Address - Street 1:150 MORRISTOWN RD
Practice Address - Street 2:STE 3AB PLAZA 202
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924
Practice Address - Country:US
Practice Address - Phone:908-766-1000
Practice Address - Fax:908-766-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G96630Medicare UPIN
028376Medicare ID - Type Unspecified