Healthcare Provider Details

I. General information

NPI: 1023163359
Provider Name (Legal Business Name): INTEGRATED BEHAVIORAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BEECHWOOD RD SUITE 3AB
SUMMIT NJ
07901
US

IV. Provider business mailing address

35 BEECHWOOD RD SUITE 3AB
SUMMIT NJ
07901
US

V. Phone/Fax

Practice location:
  • Phone: 908-598-2400
  • Fax:
Mailing address:
  • Phone: 908-598-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: STEWART R REITER
Title or Position: PRESIDENT
Credential: MD
Phone: 908-598-2400