Healthcare Provider Details

I. General information

NPI: 1316141484
Provider Name (Legal Business Name): MICHAEL VOLL V RPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 AIRPORT RD PREFERRED BEHAVIORAL HEALTH OF NJ
LAKEWOOD NJ
08701-5907
US

IV. Provider business mailing address

604 OCEAN GATE AVE PO BOX 1126
OCEAN GATE NJ
08037
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-4700
  • Fax: 732-364-2253
Mailing address:
  • Phone: 732-269-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: