Healthcare Provider Details

I. General information

NPI: 1164672150
Provider Name (Legal Business Name): STRESS CARE OF CENTRAL JERSEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3895 ROUTE 516 SUITE 2B
OLD BRIDGE NJ
08857-2499
US

IV. Provider business mailing address

3895 ROUTE 516 SUITE 2B
OLD BRIDGE NJ
08857-2499
US

V. Phone/Fax

Practice location:
  • Phone: 732-679-4500
  • Fax: 732-679-4549
Mailing address:
  • Phone: 732-679-4500
  • Fax: 732-679-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ALEX SMUKLAVSKIY
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 908-770-0703