Provider Demographics
NPI:1740092634
Name:SNFPSYCHPROVIDER
Entity type:Organization
Organization Name:SNFPSYCHPROVIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SILAO
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:201-687-7167
Mailing Address - Street 1:751 BERGEN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4705
Mailing Address - Country:US
Mailing Address - Phone:201-687-7167
Mailing Address - Fax:201-653-0917
Practice Address - Street 1:751 BERGEN AVE
Practice Address - Street 2:STE 100
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4705
Practice Address - Country:US
Practice Address - Phone:201-687-7167
Practice Address - Fax:201-653-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty