Healthcare Provider Details

I. General information

NPI: 1134080773
Provider Name (Legal Business Name): CREATIVE CARE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MARINE PLZ STE 307
NORTH BERGEN NJ
07047-6234
US

IV. Provider business mailing address

1 MARINE PLZ STE 307
NORTH BERGEN NJ
07047-6234
US

V. Phone/Fax

Practice location:
  • Phone: 201-429-5773
  • Fax: 201-425-3456
Mailing address:
  • Phone: 201-429-5773
  • Fax: 201-425-3456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BAHAR HADJIESMAEILOO
Title or Position: OWNER
Credential: MD
Phone: 703-980-5042