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General NPI Number Information
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NPI Number | 1669777280
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC CARE PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 99 IVY LN
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City | TENAFLY
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State | NJ
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Zip | 07670-2409
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Country | US
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Telephone | 201-970-4300
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Fax | 800-352-3015
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Provider Business Mailing Address
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Address Line | 99 IVY LN
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City | TENAFLY
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State | NJ
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Zip | 07670-2409
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Country | US
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Telephone | 917-682-4300
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Fax | 800-352-3015
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | WEI WANG
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Credential | M.D.
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Telephone | 917-682-4300
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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 | 25MA07675700
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License Number State | NJ
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