Provider Demographics
NPI:1952902470
Name:PERSON CENTERED SQUARED PC2
Entity Type:Organization
Organization Name:PERSON CENTERED SQUARED PC2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HERSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-995-9784
Mailing Address - Street 1:220 FERNHEAD AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8736
Mailing Address - Country:US
Mailing Address - Phone:732-305-2587
Mailing Address - Fax:
Practice Address - Street 1:220 FERNHEAD AVE
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-8736
Practice Address - Country:US
Practice Address - Phone:732-305-2587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)