=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295326247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARMONY BAY WELLNESS & TMS THERAPY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2021
-----------------------------------------------------
Last Update Date | 07/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 623 LAFAYETTE AVE STE 102C
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07506-2439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-422-2121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1399 CHEWS LANDING ROAD
-----------------------------------------------------
City | LAUREL SPRINGS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-282-1340
-----------------------------------------------------
Fax | 856-282-1340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MSO ADMINISTRATOR
-----------------------------------------------------
Name | CRYSTAL BORGESI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-282-1340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------