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General NPI Number Information
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NPI Number | 1639221161
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Entity Type | Organization
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Legal Business Name | NEW JERSEY FAMILY PSYCHIATRIC GROUP, PA
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 6 FOREST AVE
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City | PARAMUS
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State | NJ
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Zip | 07652-5241
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Country | US
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Telephone | 201-587-7850
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Fax | 201-587-0707
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Provider Business Mailing Address
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Address Line | 6 FOREST AVE
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City | PARAMUS
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State | NJ
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Zip | 07652-5241
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Country | US
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Telephone | 201-587-7850
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Fax | 201-587-0707
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Authorized Official
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Title or Position | MD
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Name | DR. DAVID A MITNICK
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Credential | MD
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Telephone | 201-587-7850
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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 | MA57877
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License Number State | NJ
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