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General NPI Number Information
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NPI Number | 1124848056
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Entity Type | Organization
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Legal Business Name | VINEYARD PSYCHIATRY
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 123 N UNION AVE STE 302
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City | CRANFORD
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State | NJ
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Zip | 07016-2198
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Country | US
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Telephone | 908-738-9185
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Fax | 908-282-3250
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Provider Business Mailing Address
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Address Line | 5 SUMMIT RD
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City | CRANFORD
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State | NJ
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Zip | 07016-1931
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Country | US
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Telephone | 646-831-1227
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHRYN GROLL
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Credential | APRN
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Telephone | 646-831-1227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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