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General NPI Number Information
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NPI Number | 1467552240
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Entity Type | Organization
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Legal Business Name | STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 101 SULLIVAN WAY
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City | TRENTON
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State | NJ
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Zip | 08628-3425
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Country | US
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Telephone | 609-633-1562
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Fax | 609-633-8527
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Provider Business Mailing Address
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Address Line | 101 SULLIVAN WAY
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City | TRENTON
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State | NJ
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Zip | 08628-3425
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Country | US
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Telephone | 609-633-1562
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Fax | 609-633-8527
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | EVAN FIEBUSCH
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Credential | M.D.
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Telephone | 609-633-1563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State | NJ
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