Healthcare Provider Details

I. General information

NPI: 1396894416
Provider Name (Legal Business Name): GERALD TRAMONTANO SENIOR CARE RESIDENTIAL AND COMMUNITY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HOWARD BLVD SUITE 205
MOUNT ARLINGTON NJ
07856-1315
US

IV. Provider business mailing address

111 HOWARD BLVD SUITE 205
MOUNT ARLINGTON NJ
07856-1315
US

V. Phone/Fax

Practice location:
  • Phone: 973-601-0100
  • Fax: 973-440-1656
Mailing address:
  • Phone: 973-601-0100
  • Fax: 973-440-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number352100333800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number03338
License Number StateNJ

VIII. Authorized Official

Name: DR. GERALD TRAMONTANO
Title or Position: CLINICAL DIRECTOR
Credential: PHD
Phone: 973-601-0100