Provider Demographics
NPI:1629558739
Name:GREEN MEADOWS THERAPY CENTER AND SERVICES
Entity Type:Organization
Organization Name:GREEN MEADOWS THERAPY CENTER AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARYEH
Authorized Official - Middle Name:
Authorized Official - Last Name:PETEGORSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-503-6119
Mailing Address - Street 1:251 OAK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-8616
Mailing Address - Country:US
Mailing Address - Phone:732-272-0177
Mailing Address - Fax:732-358-0162
Practice Address - Street 1:251 OAK GLEN RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-8616
Practice Address - Country:US
Practice Address - Phone:732-272-0177
Practice Address - Fax:732-358-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty