Provider Demographics
NPI:1467129577
Name:ADULT INTEGRATED MEDICAL AND PSYCHIATRIC CARE CONSULT.
Entity Type:Organization
Organization Name:ADULT INTEGRATED MEDICAL AND PSYCHIATRIC CARE CONSULT.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE NURSE.
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BONGAH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN, MSN
Authorized Official - Phone:862-955-3234
Mailing Address - Street 1:20 COOLIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1108
Mailing Address - Country:US
Mailing Address - Phone:862-955-3234
Mailing Address - Fax:862-955-3265
Practice Address - Street 1:40 UNION AVENUE
Practice Address - Street 2:SUITE 305
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3290
Practice Address - Country:US
Practice Address - Phone:862-955-3234
Practice Address - Fax:862-955-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty