Healthcare Provider Details

I. General information

NPI: 1255246625
Provider Name (Legal Business Name): RIVERSIDE PSYCHIATRIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 OLD TPKE
OLDWICK NJ
08858-7001
US

IV. Provider business mailing address

PO BOX 84
UPPER BLACK EDDY PA
18972-0084
US

V. Phone/Fax

Practice location:
  • Phone: 908-505-8717
  • Fax:
Mailing address:
  • Phone: 908-505-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA MARIE CODY
Title or Position: MANAGING MEMBER
Credential: PMHNP-BC
Phone: 908-505-8717