Provider Demographics
NPI:1396894416
Name:GERALD TRAMONTANO SENIOR CARE RESIDENTIAL AND COMMUNITY PROGRAM
Entity type:Organization
Organization Name:GERALD TRAMONTANO SENIOR CARE RESIDENTIAL AND COMMUNITY PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAMONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-601-0100
Mailing Address - Street 1:111 HOWARD BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MOUNT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-1315
Mailing Address - Country:US
Mailing Address - Phone:973-601-0100
Mailing Address - Fax:973-440-1656
Practice Address - Street 1:111 HOWARD BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MOUNT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-1315
Practice Address - Country:US
Practice Address - Phone:973-601-0100
Practice Address - Fax:973-440-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ352100333800103G00000X
NJ03338320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ021932Medicare PIN