Healthcare Provider Details

I. General information

NPI: 1679483242
Provider Name (Legal Business Name): ITTC EVANSVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 PROFESSIONAL BLVD
EVANSVILLE IN
47714-8000
US

IV. Provider business mailing address

1451 NEW JERSEY 88 SUITE 5
BRICK TOWNSHIP NJ
08724
US

V. Phone/Fax

Practice location:
  • Phone: 845-372-6480
  • Fax:
Mailing address:
  • Phone: 845-372-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER ZEIGER
Title or Position: OWNER
Credential:
Phone: 845-372-6480