Provider Demographics
NPI:1811398068
Name:SYNAPSE BEHAVIORAL MEDICINE LLC
Entity Type:Organization
Organization Name:SYNAPSE BEHAVIORAL MEDICINE LLC
Other - Org Name:KIRANBEN JADEJA MD LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRANBEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JADEJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-762-1857
Mailing Address - Street 1:2010 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3437
Mailing Address - Country:US
Mailing Address - Phone:732-762-1857
Mailing Address - Fax:848-999-1133
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:NBIMC
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:732-762-1857
Practice Address - Fax:848-999-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08210600273R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0143693Medicaid
NJ117174YWYMMedicare PIN