Healthcare Provider Details

I. General information

NPI: 1386876688
Provider Name (Legal Business Name): PASCACK VALLEY PSYCHIATRIC INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 CEDAR LN SUITE U6
TEANECK NJ
07666-4316
US

IV. Provider business mailing address

PO BOX 54
EMERSON NJ
07630-0054
US

V. Phone/Fax

Practice location:
  • Phone: 201-358-0400
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. PRITESH J SHAH
Title or Position: DOCTOR
Credential: M.D.
Phone: 201-358-0400