Healthcare Provider Details

I. General information

NPI: 1447763420
Provider Name (Legal Business Name): TMS RECOVERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MAIN ST STE 202
HACKENSACK NJ
07601-7307
US

IV. Provider business mailing address

235 MAIN ST STE 202
HACKENSACK NJ
07601-7307
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-8168
  • Fax: 201-880-8170
Mailing address:
  • Phone: 201-880-8168
  • Fax: 201-880-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number25MA06639300
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CARLOS MOLINA
Title or Position: OPERATION
Credential:
Phone: 551-999-3857