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General NPI Number Information
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NPI Number | 1245609932
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Entity Type | Organization
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Legal Business Name | UNION CHILD & ADOLESCENT PSYCHIATRY CENTER LLC
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 33 UPPER OVERLOOK ROAD 210
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City | SUMMIT
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State | NJ
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Zip | 07910
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Country | US
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Telephone | 908-598-0390
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Fax |
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Provider Business Mailing Address
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Address Line | 40 PINEWOOD CRES
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City | BERKELEY HEIGHTS
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State | NJ
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Zip | 07922-2144
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. INDIRA SHAH
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Credential | MD
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Telephone | 917-678-6319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 25MA08626200
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License Number State | NJ
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