Provider Demographics
NPI:1679331227
Name:IMAGO DEI BEHAVIORAL HEALTH INCORPORATED
Entity Type:Organization
Organization Name:IMAGO DEI BEHAVIORAL HEALTH INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TESTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-452-9082
Mailing Address - Street 1:1014 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1404
Mailing Address - Country:US
Mailing Address - Phone:973-874-6326
Mailing Address - Fax:
Practice Address - Street 1:1014 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1404
Practice Address - Country:US
Practice Address - Phone:973-874-6326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health