Healthcare Provider Details

I. General information

NPI: 1184748535
Provider Name (Legal Business Name): BRIDGEWAY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BROAD ST
ELIZABETH NJ
07208-3409
US

IV. Provider business mailing address

373 CLERMONT TER
UNION NJ
07083-8073
US

V. Phone/Fax

Practice location:
  • Phone: 908-355-7886
  • Fax: 908-355-6668
Mailing address:
  • Phone: 908-355-7886
  • Fax: 908-248-9376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number204010310
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number204011310
License Number StateNJ

VIII. Authorized Official

Name: MR. MOHSAN JAN
Title or Position: DIRECTOR OF BILLING & REIMBURSEMENT
Credential:
Phone: 908-355-7886