MEDICARE: PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY, INC.

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	251S00000X	Community/Behavioral Health Agency	203020348	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457418717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY, INC.

Provider Business Mailing Address
First Line	:	P.O.BOX 2036
Second Line	:	PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701
Country	:	US
Telephone Number	:	732-458-1700
Fax Number	:	732-785-3296

Provider Business Practice Location Address
First Line	:	725 AIRPORT RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5968
Country	:	US
Telephone Number	:	732-367-4700
Fax Number	:

Authorized Official
Title or Position	:	CA)
Name	:	JULIE VANORE
Credential	:
Telephone Number	:	732-458-1700

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	03/06/2019

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