Provider Demographics
NPI:1467154708
Name:MERKABA MTS, LLC.
Entity Type:Organization
Organization Name:MERKABA MTS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:732-217-4717
Mailing Address - Street 1:PO BOX 1294
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-1294
Mailing Address - Country:US
Mailing Address - Phone:732-217-4717
Mailing Address - Fax:
Practice Address - Street 1:711 STUYVESANT AVE # A
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1823
Practice Address - Country:US
Practice Address - Phone:732-217-4717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health