Provider Demographics
NPI:1407159049
Name:AFFILIATES IN CLINICAL SERVICES
Entity Type:Organization
Organization Name:AFFILIATES IN CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:908-454-7244
Mailing Address - Street 1:305 ROSEBERRY ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1600
Mailing Address - Country:US
Mailing Address - Phone:908-454-7244
Mailing Address - Fax:908-859-2109
Practice Address - Street 1:305 ROSEBERRY ST
Practice Address - Street 2:SUITE 8
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1600
Practice Address - Country:US
Practice Address - Phone:908-454-7244
Practice Address - Fax:908-859-2109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFILIATES IN CLINICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========TOtherBCBS SUFFIX