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General NPI Number Information
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NPI Number | 1326329749
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Entity Type | Organization
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Legal Business Name | AYALA CHILD & ADOLESCENT PSYCHIATRY, PC
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 2301 E EVESHAM RD SUITE 304
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City | VOORHEES
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State | NJ
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Zip | 08043-4501
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Country | US
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Telephone | 800-943-1817
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Fax | 800-943-1817
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Provider Business Mailing Address
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Address Line | 31 W 6TH AVE
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City | RUNNEMEDE
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State | NJ
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Zip | 08078-1315
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Country | US
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Telephone | 800-943-1817
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Fax | 800-943-1817
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OMAR AYALA
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Credential | M.D.
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Telephone | 800-943-1817
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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 | 25MA08727400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 25MA08727400
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License Number State | NJ
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