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General NPI Number Information
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NPI Number | 1295002343
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Entity Type | Organization
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Legal Business Name | BRANFORD PSYCHIATRIC ASSOCIATES PC
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 23 BRANFORD PL
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City | NEWARK
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State | NJ
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Zip | 07102-2711
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Country | US
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Telephone | 973-424-0080
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Fax | 973-424-0088
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Provider Business Mailing Address
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Address Line | 23 BRANFORD PL
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City | NEWARK
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State | NJ
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Zip | 07102-2711
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Country | US
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Telephone | 973-424-0080
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Fax | 973-424-0088
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Authorized Official
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Title or Position | MD
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Name | DR. EDWARD SHALTS
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Credential | MD
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Telephone | 973-424-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA07430700
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License Number State | NJ
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