Provider Demographics
NPI:1023430600
Name:NEW AGE PSYCHIATRY LLC
Entity type:Organization
Organization Name:NEW AGE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAFEER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-810-7864
Mailing Address - Street 1:4 SADDLEBURY CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9628
Mailing Address - Country:US
Mailing Address - Phone:918-810-7864
Mailing Address - Fax:
Practice Address - Street 1:480 JACKSON RD
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-1651
Practice Address - Country:US
Practice Address - Phone:856-767-5020
Practice Address - Fax:856-768-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness