Healthcare Provider Details

I. General information

NPI: 1336490838
Provider Name (Legal Business Name): MERCEDES A. PAINE, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE UNIVERSITY PLAZA SUITE 618
HACKENSACK NJ
07601-6229
US

IV. Provider business mailing address

ONE UNIVERSITY PLAZA SUITE 618
HACKENSACK NJ
07601-6229
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-4298
  • Fax: 201-487-6110
Mailing address:
  • Phone: 201-487-4298
  • Fax: 201-487-4298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MERCEDES A. PAINE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-487-4298