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General NPI Number Information
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NPI Number | 1538807011
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Entity Type | Organization
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Legal Business Name | INSITE MEDICAL NJ PA
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 525 ROUTE 73 N STE 100
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City | MARLTON
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State | NJ
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Zip | 08053-3422
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Country | US
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Telephone | 833-494-6724
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Fax |
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Provider Business Mailing Address
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Address Line | 525 ROUTE 73 N STE 302
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City | MARLTON
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State | NJ
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Zip | 08053-3422
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Country | US
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Telephone | 833-494-6724
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Fax |
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | JULIE GILLIAM
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Credential |
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Telephone | 833-494-6724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 364SP0810X
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Taxonomy Name | Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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