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General NPI Number Information
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NPI Number | 1265668149
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Entity Type | Organization
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Legal Business Name | CENTER FOR NETWORK THERAPY
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 333 CEDAR AVE BLDG. B
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City | MIDDLESEX
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State | NJ
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Zip | 08846-2400
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Country | US
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Telephone | 732-560-1080
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Fax | 732-560-1081
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Provider Business Mailing Address
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Address Line | 333 CEDAR AVE BLDG. B
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City | MIDDLESEX
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State | NJ
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Zip | 08846-2400
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Country | US
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Telephone | 732-560-1080
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Fax | 732-560-1081
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. INDRA CIDAMBI
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Credential | M.D.
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Telephone | 908-432-1929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 2000365-09
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License Number State | NJ
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