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General NPI Number Information
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NPI Number | 1720170087
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Entity Type | Organization
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Legal Business Name | KINGSBORO PSYCHIATRIC CENTER
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24 LAUREL AVENUE
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City | TENAFLY
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State | NJ
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Zip | 07670
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Country | US
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Telephone | 201-568-5395
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Fax |
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Provider Business Mailing Address
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Address Line | 24 LAUREL AVENUE
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City | TENAFLY
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State | NJ
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Zip | 07670
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Country | US
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Telephone | 201-568-5395
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Fax |
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Authorized Official
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Title or Position | ATTENDING PHYSICIAN
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Name | DR. DASEN M. BRAJKOVIC
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Credential | MD
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Telephone | 718-221-7391
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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 |
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