| Behavioral Health Specialist At Highland Llc | |
|
1 Bay Ave Montclair NJ 07042-4837 | |
| (973) 429-6000 | |
| Not Available |
| Full Name | Behavioral Health Specialist At Highland Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1 Bay Ave, Montclair, New Jersey |
| Authorized Official Name and Position | Joseph J Calabro (PRESIDENT) |
| Authorized Official Contact | 7322120060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavioral Health Specialist At Highland Llc 66 West Gilbert St. 2nd Floor Red Bank NJ 07701-4918 Ph: (732) 212-0051 | Behavioral Health Specialist At Highland Llc 1 Bay Ave Montclair NJ 07042-4837 Ph: (973) 429-6000 |
| NPI Number | 1730410481 |
|---|---|
| Provider Enumeration Date | 01/20/2010 |
| Last Update Date | 07/14/2011 |
| Medicare PECOS PAC ID | 9436282514 |
|---|---|
| Medicare Enrollment ID | O20100727000768 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730410481 | NPI | - | NPPES |
| DQ3774 | Other | NJ | RR MEDICARE |
| 0232076 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Ambrose O Mgbako |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629045323 PECOS PAC ID: 8426941949 Enrollment ID: I20040206000497 |
| Provider Name | Paul V. Kennedy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194763904 PECOS PAC ID: 4486631694 Enrollment ID: I20040706001076 |
| Provider Name | Nirmala S Rajakumar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821041294 PECOS PAC ID: 3870504079 Enrollment ID: I20060602000099 |
| Provider Name | Ki Sook Yoo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902835549 PECOS PAC ID: 6204817216 Enrollment ID: I20070301000002 |
| Provider Name | Amel A Badr |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528262904 PECOS PAC ID: 8820156466 Enrollment ID: I20081025000005 |
| Provider Name | Veronica M Jensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700021391 PECOS PAC ID: 9830247568 Enrollment ID: I20090506000295 |
| Provider Name | Ketaki Vaidhyanathan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992904445 PECOS PAC ID: 0446309645 Enrollment ID: I20090519000058 |
| Provider Name | Edward L Farkas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154313955 PECOS PAC ID: 2365572799 Enrollment ID: I20100611000337 |
| Provider Name | Juan Riestra |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841255320 PECOS PAC ID: 9234263625 Enrollment ID: I20100820000622 |
| Provider Name | Michael Zajfert |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740581263 PECOS PAC ID: 7315125598 Enrollment ID: I20110617000614 |
| Provider Name | Marek Belz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073732699 PECOS PAC ID: 0446492631 Enrollment ID: I20130819000500 |
| Provider Name | Ali R Surahio |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558764910 PECOS PAC ID: 3173843372 Enrollment ID: I20150528001803 |
| Provider Name | Maryam Rakhmatullina |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831328830 PECOS PAC ID: 6709182173 Enrollment ID: I20160420000209 |
| Provider Name | Olubunmi Adetule |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245786979 PECOS PAC ID: 9638450422 Enrollment ID: I20170110003094 |
| Provider Name | Jonathan A Hertz |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881747152 PECOS PAC ID: 8820014160 Enrollment ID: I20180522000313 |
| Provider Name | Angela N Anukam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841734944 PECOS PAC ID: 1951666940 Enrollment ID: I20180522001184 |
| Provider Name | Jeffrey Hall |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285923573 PECOS PAC ID: 2163741349 Enrollment ID: I20190205000670 |
| Provider Name | Sylvana J Garcia Morales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699280099 PECOS PAC ID: 8224376538 Enrollment ID: I20190212002106 |
| Provider Name | Nwayieze Ndukwe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326381203 PECOS PAC ID: 3173863966 Enrollment ID: I20190313002288 |
| Provider Name | Mehr Iqbal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013264035 PECOS PAC ID: 2062783020 Enrollment ID: I20191107000579 |
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