Healthcare Provider Details

I. General information

NPI: 1376393587
Provider Name (Legal Business Name): CHILD, ADOLESCENT AND ADULT PSYCHIATRIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 N GRANT AVE
COLONIA NJ
07067-2208
US

IV. Provider business mailing address

42 N GRANT AVE
COLONIA NJ
07067-2208
US

V. Phone/Fax

Practice location:
  • Phone: 848-999-9756
  • Fax:
Mailing address:
  • Phone: 848-999-9756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SYED JAWAD TIRMAZI
Title or Position: SOLE OWNER PROVIDER
Credential: MD
Phone: 848-999-9756