Provider Demographics
NPI:1780726638
Name:CHATHAM PSYCHIATRIC GROUP, P.A.
Entity type:Organization
Organization Name:CHATHAM PSYCHIATRIC GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIE
Authorized Official - Middle Name:JOHAN
Authorized Official - Last Name:NOORDSIJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-277-7676
Mailing Address - Street 1:9 TULIP ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2404
Mailing Address - Country:US
Mailing Address - Phone:908-277-7676
Mailing Address - Fax:908-277-4900
Practice Address - Street 1:9 TULIP ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2404
Practice Address - Country:US
Practice Address - Phone:908-277-7676
Practice Address - Fax:908-277-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA1777900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3876004Medicaid
NJC56817Medicare UPIN
NJNO520983Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER