Healthcare Provider Details

I. General information

NPI: 1811053101
Provider Name (Legal Business Name): COMMUNITY PSYCHIATRIC INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 SANFORD ST
EAST ORANGE NJ
07018-1926
US

IV. Provider business mailing address

67 SANFORD ST
EAST ORANGE NJ
07018-1926
US

V. Phone/Fax

Practice location:
  • Phone: 973-673-3342
  • Fax: 973-673-5612
Mailing address:
  • Phone: 973-673-3342
  • Fax: 973-673-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number07181-01-05
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN N. FURST
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 973-673-3342