Provider Demographics
NPI:1518425040
Name:NJ MEMORY CENTER, LLC
Entity Type:Organization
Organization Name:NJ MEMORY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURCHETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:201-577-8286
Mailing Address - Street 1:80 POMPTON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2913
Mailing Address - Country:US
Mailing Address - Phone:201-577-8286
Mailing Address - Fax:201-479-0299
Practice Address - Street 1:80 POMPTON AVE STE 106
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2913
Practice Address - Country:US
Practice Address - Phone:201-577-8286
Practice Address - Fax:201-479-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty