Provider Demographics
NPI:1205609872
Name:GARDEN STATE PSYCHIATRIC ASSOCIATES LLC
Entity type:Organization
Organization Name:GARDEN STATE PSYCHIATRIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:APN, PMNHP-BC
Authorized Official - Phone:732-301-6904
Mailing Address - Street 1:509 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7402
Mailing Address - Country:US
Mailing Address - Phone:732-301-6904
Mailing Address - Fax:
Practice Address - Street 1:509 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7402
Practice Address - Country:US
Practice Address - Phone:732-301-6904
Practice Address - Fax:563-276-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty