Healthcare Provider Details

I. General information

NPI: 1184963837
Provider Name (Legal Business Name): PROSPECT PSYCHIATRIC SERVICES LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 PROSPECT AVE APT 1A
HACKENSACK NJ
07601-2602
US

IV. Provider business mailing address

344 PROSPECT AVE APT 1A
HACKENSACK NJ
07601-2602
US

V. Phone/Fax

Practice location:
  • Phone: 917-330-3955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA09230100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. INDHIRA F ALMONTE
Title or Position: OWNER
Credential: MD
Phone: 917-330-3955