Healthcare Provider Details

I. General information

NPI: 1275908550
Provider Name (Legal Business Name): GUTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E RIDGEWOOD AVE
PARAMUS NJ
07652-4819
US

IV. Provider business mailing address

540 FARVIEW AVENUE
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-6000
  • Fax: 201-291-0492
Mailing address:
  • Phone: 201-343-6000
  • Fax: 201-996-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
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: MR. JOHN SUSINO
Title or Position: SCHOOL BUSINESS ADMINISTRATOR
Credential:
Phone: 201-343-6000