Healthcare Provider Details

I. General information

NPI: 1851756498
Provider Name (Legal Business Name): TQ BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 CEDAR BRIDGE AVE SUITE B
BRICK NJ
08723-4170
US

IV. Provider business mailing address

1065 US HIGHWAY 22 SUITE 3B
BRIDGEWATER NJ
08807-2949
US

V. Phone/Fax

Practice location:
  • Phone: 908-526-8370
  • Fax:
Mailing address:
  • Phone: 908-526-8370
  • Fax: 908-801-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA07291000
License Number StateNJ

VIII. Authorized Official

Name: HENRY ODUNLAMI
Title or Position: CEO
Credential: MD
Phone: 908-526-8370