Provider Demographics
NPI:1659410439
Name:SUBURBAN TREATMENT ASSOCIATES
Entity Type:Organization
Organization Name:SUBURBAN TREATMENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-687-7188
Mailing Address - Street 1:43 PROGRESS ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8114
Mailing Address - Country:US
Mailing Address - Phone:908-687-7188
Mailing Address - Fax:908-687-0294
Practice Address - Street 1:43 PROGRESS ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8114
Practice Address - Country:US
Practice Address - Phone:908-687-7188
Practice Address - Fax:908-687-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22315261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8868905Medicaid