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General NPI Number Information
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NPI Number | 1184748535
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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 | 03/19/2007
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 615 N BROAD ST
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City | ELIZABETH
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State | NJ
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Zip | 07208-3409
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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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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 | 908-248-9376
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 204011310
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 204010310
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License Number State | NJ
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