Healthcare Provider Details

I. General information

NPI: 1205676079
Provider Name (Legal Business Name): RS SOS PISCATAWAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 OLD NEW BRUNSWICK RD STE 140
PISCATAWAY NJ
08854-3999
US

IV. Provider business mailing address

242 OLD NEW BRUNSWICK RD STE 140
PISCATAWAY NJ
08854-3999
US

V. Phone/Fax

Practice location:
  • Phone: 732-505-7334
  • Fax: 732-379-4346
Mailing address:
  • Phone: 732-505-7334
  • Fax: 732-379-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SAGAR PATEL
Title or Position: CEO / OWNER
Credential:
Phone: 732-814-9091