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General NPI Number Information
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NPI Number | 1235568098
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Entity Type | Organization
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Legal Business Name | MEDALLION BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/02/2013
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Provider Practice Location Address
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Address Line | 470 COLFAX AVE
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City | CLIFTON
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State | NJ
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Zip | 07013-1624
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Country | US
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Telephone | 732-600-6424
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Fax |
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Provider Business Mailing Address
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Address Line | 470 COLFAX AVE
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City | CLIFTON
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State | NJ
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Zip | 07013-1624
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Country | US
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Telephone | 732-600-6424
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Fax |
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Authorized Official
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Title or Position | MEMEBER
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Name | MR. SHLOMO GREENZWEIG
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Credential |
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Telephone | 732-600-6424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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