MEDICARE: RUTGERS HEALTH - BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1144267337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUTGERS HEALTH - BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	671 HOES LN W
Second Line	:	PO BOX 1392
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-8021
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	671 HOES LN W RM D-338I
Second Line	:
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-8021
Country	:	US
Telephone Number	:	732-235-3289
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. CARL O'BRIEN
Credential	:
Telephone Number	:	732-235-5940

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/31/2017

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