Provider Demographics
NPI:1952733875
Name:PSYCHIATRY SERVICES
Entity Type:Organization
Organization Name:PSYCHIATRY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-536-9890
Mailing Address - Street 1:180 TUCKERTON RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8802
Mailing Address - Country:US
Mailing Address - Phone:609-536-9890
Mailing Address - Fax:609-423-0970
Practice Address - Street 1:180 TUCKERTON RD
Practice Address - Street 2:SUITE 11
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8802
Practice Address - Country:US
Practice Address - Phone:609-536-9890
Practice Address - Fax:609-423-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00099700305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization