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General NPI Number Information
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NPI Number | 1326214149
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Entity Type | Organization
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Legal Business Name | NORTH JERSEY BEHAVIORAL MEDICINE
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 2 EXECUTIVE DR SUITE 665
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City | FORT LEE
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State | NJ
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Zip | 07024-3308
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Country | US
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Telephone | 201-669-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 2 EXECUTIVE DR SUITE 665
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City | FORT LEE
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State | NJ
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Zip | 07024-3308
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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 | ADULT AND PEDIATRIC PSYCHIATRIST
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Name | DR. MONA S ISMAIL
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Credential | MD
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Telephone | 201-669-2880
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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 | 37PC00296100
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License Number State | NJ
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