Provider Demographics
NPI:1649309386
Name:SOMERSET MEDICAL CENTER BEHAVIORAL HEALTH UNIT
Entity type:Organization
Organization Name:SOMERSET MEDICAL CENTER BEHAVIORAL HEALTH UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCIAL OPERATIONS & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:908-685-2807
Mailing Address - Street 1:110 REHILL AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2519
Mailing Address - Country:US
Mailing Address - Phone:908-704-3795
Mailing Address - Fax:908-252-4056
Practice Address - Street 1:110 REHILL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:908-704-3795
Practice Address - Fax:908-252-4056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11802273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4138406Medicaid
31S048Medicare ID - Type Unspecified