Healthcare Provider Details

I. General information

NPI: 1093448599
Provider Name (Legal Business Name): EZ MIND FAMILY MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2022
Last Update Date: 07/03/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MAIN ST
LANOKA HARBOR NJ
08734-2228
US

IV. Provider business mailing address

500 MAIN ST
LANOKA HARBOR NJ
08734-2228
US

V. Phone/Fax

Practice location:
  • Phone: 609-916-6443
  • Fax: 732-358-0829
Mailing address:
  • Phone: 609-916-6443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAN FORD
Title or Position: PMHNP/FNP
Credential: APN
Phone: 609-916-6443