Provider Demographics
NPI:1851392872
Name:NEW BEHAVIORAL NETWORK ,INC
Entity Type:Organization
Organization Name:NEW BEHAVIORAL NETWORK ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOETTCHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:856-669-0217
Mailing Address - Street 1:2 PIN OAK LN
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1632
Mailing Address - Country:US
Mailing Address - Phone:856-669-0211
Mailing Address - Fax:856-424-8919
Practice Address - Street 1:2 PIN OAK LN
Practice Address - Street 2:UNIT 250
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:302-892-9210
Practice Address - Fax:302-892-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE251E00000X
NJ251E00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00019496Medicaid