Provider Demographics
NPI:1407201759
Name:RUTGERS ANXIETY DISORDERS CLINIC
Entity Type:Organization
Organization Name:RUTGERS ANXIETY DISORDERS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIDOMENICO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-445-5384
Mailing Address - Street 1:797 HOES LN W
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-8022
Mailing Address - Country:US
Mailing Address - Phone:732-445-5384
Mailing Address - Fax:732-445-5230
Practice Address - Street 1:797 HOES LN W
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-8022
Practice Address - Country:US
Practice Address - Phone:732-445-5384
Practice Address - Fax:732-445-5230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTGERS, THE STATE UNIVERSITY OF NJ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-24
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00364600261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)