Healthcare Provider Details

I. General information

NPI: 1629558739
Provider Name (Legal Business Name): GREEN MEADOWS THERAPY CENTER AND SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 OAK GLEN RD
HOWELL NJ
07731-8616
US

IV. Provider business mailing address

251 OAK GLEN RD
HOWELL NJ
07731-8616
US

V. Phone/Fax

Practice location:
  • Phone: 732-272-0177
  • Fax: 732-358-0162
Mailing address:
  • Phone: 732-272-0177
  • Fax: 732-358-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARYEH PETEGORSKY
Title or Position: MANAGER
Credential:
Phone: 732-503-6119