Healthcare Provider Details

I. General information

NPI: 1912487919
Provider Name (Legal Business Name): BETH P JASSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2018
Last Update Date: 08/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 ESSEX ST
MILLBURN NJ
07041
US

IV. Provider business mailing address

20 STAFFORD DR
MADISON NJ
07940-2013
US

V. Phone/Fax

Practice location:
  • Phone: 908-484-4204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BETH JASSIN
Title or Position: OWNER/PROVIDER
Credential:
Phone: 908-484-4204