Provider Demographics
NPI:1891325791
Name:GODBRIDGE INTERGRATED CARE
Entity Type:Organization
Organization Name:GODBRIDGE INTERGRATED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTISE NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSI
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:973-489-7101
Mailing Address - Street 1:6 WYCKOFF PL
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1816
Mailing Address - Country:US
Mailing Address - Phone:973-489-7101
Mailing Address - Fax:
Practice Address - Street 1:6 WYCKOFF PL
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1816
Practice Address - Country:US
Practice Address - Phone:973-489-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty