| Bergen Psychiatric Care Llc | |
|
65 N Maple Ave Ste 104 Ridgewood NJ 07450-3233 | |
| (201) 956-9483 | |
| (201) 288-5262 |
| Full Name | Bergen Psychiatric Care Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 65 N Maple Ave Ste 104, Ridgewood, New Jersey |
| Authorized Official Name and Position | Mini Thomas (CCRP) |
| Authorized Official Contact | 2019569483 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bergen Psychiatric Care Llc 65 N Maple Ave Ste 104 Ridgewood NJ 07450-3233 Ph: (201) 956-9483 | Bergen Psychiatric Care Llc 65 N Maple Ave Ste 104 Ridgewood NJ 07450-3233 Ph: (201) 956-9483 |
| NPI Number | 1295255149 |
|---|---|
| Provider Enumeration Date | 06/21/2017 |
| Last Update Date | 03/18/2019 |
| Medicare PECOS PAC ID | 6608149604 |
|---|---|
| Medicare Enrollment ID | O20170913000215 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295255149 | NPI | - | NPPES |
| 25MA09523700 | Other | NJ | STATE LICENCE |
| Provider Name | Manoj Puthiyathu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649408956 PECOS PAC ID: 7416279617 Enrollment ID: I20141125000429 |
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