Provider Demographics
NPI:1568771921
Name:COMMUNITY PSYCHIATRIC INTITUTE
Entity Type:Organization
Organization Name:COMMUNITY PSYCHIATRIC INTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:FURST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-673-3342
Mailing Address - Street 1:67 SANFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1926
Mailing Address - Country:US
Mailing Address - Phone:973-673-3342
Mailing Address - Fax:973-673-5612
Practice Address - Street 1:67 SANFORD ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1926
Practice Address - Country:US
Practice Address - Phone:973-673-3342
Practice Address - Fax:973-673-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000338-10324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0232891Medicaid
NJ0232564Medicaid