Provider Demographics
NPI:1891779625
Name:THE VAN OST INSTITUTE FOR FAMILY LIVING
Entity Type:Organization
Organization Name:THE VAN OST INSTITUTE FOR FAMILY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:201-569-6667
Mailing Address - Street 1:150 E PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3013
Mailing Address - Country:US
Mailing Address - Phone:201-569-6667
Mailing Address - Fax:201-569-7504
Practice Address - Street 1:150 E PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3013
Practice Address - Country:US
Practice Address - Phone:201-569-6667
Practice Address - Fax:201-569-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ222952084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7734204Medicaid
NJ025337BWSMedicare ID - Type Unspecified
NJ7734204Medicaid