| Abby Road Psychiatric Services Llc | |
|
7 Hendrickson Ave Red Bank NJ 07701-6122 | |
| (732) 893-5316 | |
| Not Available |
| Full Name | Abby Road Psychiatric Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7 Hendrickson Ave, Red Bank, New Jersey |
| Authorized Official Name and Position | Anthony Dimura (OWNER) |
| Authorized Official Contact | 9084337263 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abby Road Psychiatric Services Llc 7 Hendrickson Ave Red Bank NJ 07701-6122 Ph: (732) 893-5316 | Abby Road Psychiatric Services Llc 7 Hendrickson Ave Red Bank NJ 07701-6122 Ph: (732) 893-5316 |
| NPI Number | 1053807305 |
|---|---|
| Provider Enumeration Date | 07/10/2018 |
| Last Update Date | 08/05/2023 |
| Certification Date | 08/05/2023 |
| Medicare PECOS PAC ID | 1658615638 |
|---|---|
| Medicare Enrollment ID | O20181203000118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053807305 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Gregory Coram |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548373384 PECOS PAC ID: 3375507395 Enrollment ID: I20041118000470 |
| Provider Name | Christine Schruntek |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1083643324 PECOS PAC ID: 5698711935 Enrollment ID: I20050810001240 |
| Provider Name | Courtney Np Wuss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326593286 PECOS PAC ID: 0941589790 Enrollment ID: I20161117002571 |
| Provider Name | Jace Arliss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265983928 PECOS PAC ID: 4486938826 Enrollment ID: I20170302000058 |
| Provider Name | Anthony Dimura |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124520333 PECOS PAC ID: 9830452903 Enrollment ID: I20180424002609 |
| Provider Name | Amy L Tarr |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720413677 PECOS PAC ID: 9739444837 Enrollment ID: I20180518002108 |
| Provider Name | Heather Mccooey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568818144 PECOS PAC ID: 9830447580 Enrollment ID: I20180813001235 |
| Provider Name | Tony Dicken |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124620364 PECOS PAC ID: 8527474220 Enrollment ID: I20210303003266 |
| Provider Name | Samantha Dicken |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437888500 PECOS PAC ID: 9335522812 Enrollment ID: I20220816002064 |
| Provider Name | Jessica Kirby-smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013612902 PECOS PAC ID: 5395190193 Enrollment ID: I20231014000189 |
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