Basic Information
Provider Information
NPI: 1104330356
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARTON
FirstName: ELLEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APN
OtherOrganizationName:  
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Mailing Information
Address1: 1200 JUMPING BROOK ROAD
Address2: BLDG 5, STE 201, ATTN: BEHAVIORAL HEALTH CREDENTIALING
City: NEPTUNE
State: NJ
PostalCode: 07753
CountryCode: US
TelephoneNumber: 7326434372
FaxNumber: 7326434376
Practice Location
Address1: 1945 ROUTE 33
Address2:  
City: NEPTUNE
State: NJ
PostalCode: 077534859
CountryCode: US
TelephoneNumber: 7326434363
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/27/2017
LastUpdateDate: 11/27/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808X26NJ00039500NJY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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