Provider Demographics
NPI:1821555376
Name:EXECUTIVE CENTER FOR PSYCHOLOGICAL MEDICINE
Entity Type:Organization
Organization Name:EXECUTIVE CENTER FOR PSYCHOLOGICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADETUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-918-9672
Mailing Address - Street 1:701 WHITE HORSE RD STE C-101
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2494
Mailing Address - Country:US
Mailing Address - Phone:267-918-9672
Mailing Address - Fax:
Practice Address - Street 1:701 WHITE HORSE RD STE C-101
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2494
Practice Address - Country:US
Practice Address - Phone:267-918-9672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0202266Medicaid