=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558363127
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF UNION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2005
-----------------------------------------------------
Last Update Date | 12/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 WATCHUNG WAY CORNERSTONE ADMINISTRATIVE SUITE
-----------------------------------------------------
City | BERKELEY HEIGHTS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07922-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-771-5705
-----------------------------------------------------
Fax | 908-771-5820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 WATCHUNG WAY CORNERSTONE ADMINISTRATIVE SUITE
-----------------------------------------------------
City | BERKELEY HEIGHTS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07922-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-771-5705
-----------------------------------------------------
Fax | 908-771-5820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNTY COMPTROLLER
-----------------------------------------------------
Name | MR. ERICK MESIAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-527-4754
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------