MEDICARE: NORTH JERSEY PSYCHIATRY,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	305S00000X	Point of Service	MA71572	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	:	1831468263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH JERSEY PSYCHIATRY,INC

Provider Business Mailing Address
First Line	:	31 W RUBY AVE
Second Line	:
City	:	PALISADES PARK
State	:	NJ
Zip	:	07650-1008
Country	:	US
Telephone Number	:	201-861-0077
Fax Number	:	201-861-9595

Provider Business Practice Location Address
First Line	:	5912 PALISADE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-2112
Country	:	US
Telephone Number	:	201-861-0077
Fax Number	:	201-861-9595

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL RENE SANCHEZ
Credential	:	M.D.
Telephone Number	:	201-861-0077

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	01/06/2012

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