Healthcare Provider Details

I. General information

NPI: 1821341439
Provider Name (Legal Business Name): TOTAL SPECTRUM HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 WOODPORT RD
SPARTA NJ
07871-2633
US

IV. Provider business mailing address

171 WOODPORT RD
SPARTA NJ
07871-2633
US

V. Phone/Fax

Practice location:
  • Phone: 973-726-3001
  • Fax: 973-726-3002
Mailing address:
  • Phone: 973-726-3001
  • Fax: 973-726-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB07388800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MB07388800
License Number StateNJ

VIII. Authorized Official

Name: DR. JENNY A BLANCHARD
Title or Position: OWNER
Credential: D.O.
Phone: 973-726-3001