Provider Demographics
NPI:1831651876
Name:MENTAL HEALTH AND ADDICTION CENTER,
Entity Type:Organization
Organization Name:MENTAL HEALTH AND ADDICTION CENTER,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SILAO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, MA, APN
Authorized Official - Phone:917-597-0082
Mailing Address - Street 1:751 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4705
Mailing Address - Country:US
Mailing Address - Phone:201-687-7167
Mailing Address - Fax:201-653-0917
Practice Address - Street 1:751 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4705
Practice Address - Country:US
Practice Address - Phone:201-687-7167
Practice Address - Fax:201-653-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty