Provider Demographics
NPI:1639221161
Name:NEW JERSEY FAMILY PSYCHIATRIC GROUP, PA
Entity Type:Organization
Organization Name:NEW JERSEY FAMILY PSYCHIATRIC GROUP, PA
Other - Org Name:NJFPG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-587-7850
Mailing Address - Street 1:6 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5241
Mailing Address - Country:US
Mailing Address - Phone:201-587-7850
Mailing Address - Fax:201-587-0707
Practice Address - Street 1:6 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5241
Practice Address - Country:US
Practice Address - Phone:201-587-7850
Practice Address - Fax:201-587-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA578772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1639221161Medicare PIN