Healthcare Provider Details

I. General information

NPI: 1417499260
Provider Name (Legal Business Name): JERSEY SHORE PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 AVENEL ST
AVENEL NJ
07001-1150
US

IV. Provider business mailing address

432 AVENEL ST
AVENEL NJ
07001-1150
US

V. Phone/Fax

Practice location:
  • Phone: 732-426-7030
  • Fax: 609-479-2781
Mailing address:
  • Phone: 732-426-7030
  • Fax: 609-479-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number25MA09092000
License Number StateNJ

VIII. Authorized Official

Name: DR. MUHAMMAD A ABBAS
Title or Position: CEO
Credential:
Phone: 732-426-7030