Provider Demographics
NPI:1790966034
Name:PLAINFIELD CONSULTATION CENTER
Entity Type:Organization
Organization Name:PLAINFIELD CONSULTATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:AYLWARD
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:908-757-4921
Mailing Address - Street 1:32 JOHNSTON DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-4905
Mailing Address - Country:US
Mailing Address - Phone:908-757-4921
Mailing Address - Fax:908-757-6860
Practice Address - Street 1:32 JOHNSTON DR
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-4905
Practice Address - Country:US
Practice Address - Phone:908-757-4921
Practice Address - Fax:908-757-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1670103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ426471Medicare PIN