Provider Demographics
NPI:1801651864
Name:ALBATROSS TO PHOENIX PSYCHIATRY LLC
Entity type:Organization
Organization Name:ALBATROSS TO PHOENIX PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE NURSE
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:862-774-4562
Mailing Address - Street 1:111 TOWN SQUARE PL
Mailing Address - Street 2:SUITE 1238 PMB 801874
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 TOWN SQUARE PL STE 1238
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1810
Practice Address - Country:US
Practice Address - Phone:201-757-2531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty