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General NPI Number Information
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NPI Number | 1164123105
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Entity Type | Organization
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Legal Business Name | BRIDGEWAY BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 03/16/2023
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 373 CLERMONT TER
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City | UNION
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State | NJ
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Zip | 07083-8073
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Country | US
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Telephone | 908-355-7886
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Fax |
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Provider Business Mailing Address
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Address Line | 373 CLERMONT TER
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City | UNION
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State | NJ
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Zip | 07083-8073
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Country | US
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Telephone | 908-355-7886
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Fax | 908-355-6668
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Authorized Official
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Title or Position | DIRECTOR OF BILLING & REIMBURSEMENT
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Name | MR. MOHSAN JAN
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Credential |
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Telephone | 908-355-7886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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