Provider Demographics
NPI:1982791190
Name:BAY SHORE MARRIAGE AND FAMILY CONSULTANTS
Entity Type:Organization
Organization Name:BAY SHORE MARRIAGE AND FAMILY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SMELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-264-2440
Mailing Address - Street 1:717 N BEERS ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1524
Mailing Address - Country:US
Mailing Address - Phone:732-264-2440
Mailing Address - Fax:732-888-7767
Practice Address - Street 1:717 N BEERS ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1524
Practice Address - Country:US
Practice Address - Phone:732-264-2440
Practice Address - Fax:732-888-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00086400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ461824Medicare ID - Type Unspecified
NJ786962A7WMedicare PIN
NJ786962Medicare PIN