Healthcare Provider Details

I. General information

NPI: 1821800913
Provider Name (Legal Business Name): SNFPSYCHPROVIDER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 BERGEN AVE STE 100
JERSEY CITY NJ
07306-4705
US

IV. Provider business mailing address

751 BERGEN AVE STE 100
JERSEY CITY NJ
07306-4705
US

V. Phone/Fax

Practice location:
  • Phone: 201-687-7167
  • Fax: 201-653-0917
Mailing address:
  • Phone: 201-687-7167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. NICHOLAS SILAO
Title or Position: DIRECTOR
Credential: CRNA, MA, APN
Phone: 917-597-0082