Provider Demographics
NPI:1578235123
Name:WITHIN HEALTH PROVIDER SERVICES NJ LLC
Entity Type:Organization
Organization Name:WITHIN HEALTH PROVIDER SERVICES NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKERT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:866-918-2114
Mailing Address - Street 1:2665 S BAYSHORE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5402
Mailing Address - Country:US
Mailing Address - Phone:866-918-2114
Mailing Address - Fax:
Practice Address - Street 1:299 GLENWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2445
Practice Address - Country:US
Practice Address - Phone:866-918-2114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health