Healthcare Provider Details

I. General information

NPI: 1639957772
Provider Name (Legal Business Name): IDEAL PSYCH BEHAVIORAL HEALTH LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 BORDENTOWN AVE, 3RD FLOOR ROOM 18
PARLIN NJ
08859-0885
US

IV. Provider business mailing address

23 QUINCY CIR
DAYTON NJ
08810-1331
US

V. Phone/Fax

Practice location:
  • Phone: 862-264-8062
  • Fax: 862-418-4933
Mailing address:
  • Phone: 862-264-8062
  • Fax: 732-553-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. EMILY WANYOIKE
Title or Position: PRESIDENT
Credential: DNP
Phone: 862-264-8062