Provider Demographics
NPI:1982918686
Name:JEFFREY M. HIMMEL
Entity Type:Organization
Organization Name:JEFFREY M. HIMMEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:857-371-5827
Mailing Address - Street 1:105 N BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-1629
Mailing Address - Country:US
Mailing Address - Phone:856-371-5827
Mailing Address - Fax:
Practice Address - Street 1:105 N BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-1629
Practice Address - Country:US
Practice Address - Phone:856-371-5827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05288000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health