Healthcare Provider Details

I. General information

NPI: 1790199537
Provider Name (Legal Business Name): MONA W. BIRK, PHD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 HOPKINSON CT
BASKING RIDGE NJ
07920-2982
US

IV. Provider business mailing address

32 HOPKINSON CT
BASKING RIDGE NJ
07920-2982
US

V. Phone/Fax

Practice location:
  • Phone: 908-306-0774
  • Fax: 908-306-0607
Mailing address:
  • Phone: 908-306-0774
  • Fax: 908-306-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number26NC04510500
License Number StateNJ

VIII. Authorized Official

Name: MONA BIRK
Title or Position: PRESIDENT
Credential: PHD
Phone: 908-307-3768