Provider Demographics
NPI:1942348776
Name:NEUROBEHAVIORAL INSTITUTE OF NEW JERSEY, P.A.
Entity Type:Organization
Organization Name:NEUROBEHAVIORAL INSTITUTE OF NEW JERSEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-725-8877
Mailing Address - Street 1:626 N THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1343
Mailing Address - Country:US
Mailing Address - Phone:908-725-8877
Mailing Address - Fax:
Practice Address - Street 1:626 N THOMPSON ST
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1343
Practice Address - Country:US
Practice Address - Phone:908-725-8877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4390103G00000X, 103T00000X, 103TC0700X
NJ3834103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ626079Medicare ID - Type UnspecifiedPROVIDER NUMBER