Healthcare Provider Details

I. General information

NPI: 1518646538
Provider Name (Legal Business Name): TRANSFORMATIONAL HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 TOWN SQUARE PL STE 1203
JERSEY CITY NJ
07310-2784
US

IV. Provider business mailing address

111 TOWN SQUARE PL STE 1203
JERSEY CITY NJ
07310-2784
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-4549
  • Fax: 908-652-9230
Mailing address:
  • Phone: 888-344-4549
  • Fax: 908-652-9230

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: SIMEON MERTYL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 888-344-4549