Provider Demographics
NPI:1295156065
Name:SYNAPSE BEHAVIORAL MEDICINE LLC
Entity type:Organization
Organization Name:SYNAPSE BEHAVIORAL MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRANBEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JADEJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-762-1857
Mailing Address - Street 1:217 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1164
Mailing Address - Country:US
Mailing Address - Phone:732-762-1857
Mailing Address - Fax:848-999-1133
Practice Address - Street 1:2010 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3437
Practice Address - Country:US
Practice Address - Phone:732-762-1857
Practice Address - Fax:848-999-1133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYNAPSE BEHAVIORAL MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-22
Last Update Date:2013-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08210600261QM0850X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health