Healthcare Provider Details

I. General information

NPI: 1295156065
Provider Name (Legal Business Name): SYNAPSE BEHAVIORAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2013
Last Update Date: 12/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 SPRINGFIELD AVE
MAPLEWOOD NJ
07040-3437
US

IV. Provider business mailing address

217 WESTGATE DR
EDISON NJ
08820-1164
US

V. Phone/Fax

Practice location:
  • Phone: 732-762-1857
  • Fax: 848-999-1133
Mailing address:
  • Phone: 732-762-1857
  • Fax: 848-999-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number25MA08210600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number25MA08210600
License Number StateNJ

VIII. Authorized Official

Name: DR. KIRANBEN J JADEJA
Title or Position: PSYCHIATRIST
Credential: M.D
Phone: 732-762-1857