Provider Demographics
NPI:1134627979
Name:MENTAL HEALTH CLINIC OF ELIZABETH, NJ INCORPORATED
Entity type:Organization
Organization Name:MENTAL HEALTH CLINIC OF ELIZABETH, NJ INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:URMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-322-3454
Mailing Address - Street 1:520 WESTFIELD AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1646
Mailing Address - Country:US
Mailing Address - Phone:908-469-8483
Mailing Address - Fax:908-469-8483
Practice Address - Street 1:520 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1658
Practice Address - Country:US
Practice Address - Phone:908-466-8484
Practice Address - Fax:908-466-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00477000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty