=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295156065
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYNAPSE BEHAVIORAL MEDICINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2013
-----------------------------------------------------
Last Update Date | 12/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2010 SPRINGFIELD AVE
-----------------------------------------------------
City | MAPLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07040-3437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-762-1857
-----------------------------------------------------
Fax | 848-999-1133
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 217 WESTGATE DR
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08820-1164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-762-1857
-----------------------------------------------------
Fax | 848-999-1133
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST
-----------------------------------------------------
Name | DR. KIRANBEN J JADEJA
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 732-762-1857
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 25MA08210600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 25MA08210600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------