Provider Demographics
NPI:1720367832
Name:INSYTE PSYCHIATRIC LLC
Entity Type:Organization
Organization Name:INSYTE PSYCHIATRIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-551-5550
Mailing Address - Street 1:33 PLYMOUTH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2677
Mailing Address - Country:US
Mailing Address - Phone:732-551-5550
Mailing Address - Fax:
Practice Address - Street 1:33 PLYMOUTH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2677
Practice Address - Country:US
Practice Address - Phone:732-551-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-06
Last Update Date:2011-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA087068002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1346562857OtherNPI