Healthcare Provider Details

I. General information

NPI: 1023493731
Provider Name (Legal Business Name): I-U BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 BRUNSWICK WOODS DR
EAST BRUNSWICK NJ
08816-5601
US

IV. Provider business mailing address

56 BRUNSWICK WOODS DR
EAST BRUNSWICK NJ
08816-5601
US

V. Phone/Fax

Practice location:
  • Phone: 732-685-3224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TISHA SIMMS
Title or Position: BEHAVIOR ANALYST
Credential:
Phone: 732-685-3224