Provider Demographics
NPI:1770350837
Name:NEW JERSEY PSYCHIATRIC CLINIC
Entity type:Organization
Organization Name:NEW JERSEY PSYCHIATRIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:NANA
Authorized Official - Last Name:KUSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-515-1661
Mailing Address - Street 1:3 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3243
Mailing Address - Country:US
Mailing Address - Phone:201-515-1661
Mailing Address - Fax:
Practice Address - Street 1:2510 BELMAR BLVD STE I-18
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3984
Practice Address - Country:US
Practice Address - Phone:732-800-8693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty