Provider Demographics
NPI:1780188060
Name:PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY, INC
Entity Type:Organization
Organization Name:PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-458-1700
Mailing Address - Street 1:PO BOX 2036
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-8036
Mailing Address - Country:US
Mailing Address - Phone:732-458-1700
Mailing Address - Fax:732-785-3296
Practice Address - Street 1:1191 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-4172
Practice Address - Country:US
Practice Address - Phone:732-323-3664
Practice Address - Fax:732-244-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NJ2000557261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2000557OtherSTATE LICENSE