Basic Information
| Provider Information | |||||||||
| NPI: | 1205218971 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BANCROFT NEUROHEALTH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BANCROFT-PLAINSBORO | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 CALDWELL ROAD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563484011 | ||||||||
| FaxNumber: | 8562161269 | ||||||||
| Practice Location | |||||||||
| Address1: | 666 PLAINSBORO ROAD SUITE 2000C | ||||||||
| Address2: | |||||||||
| City: | PLAINSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322061577 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2015 | ||||||||
| LastUpdateDate: | 12/14/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CRIPPS | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8563481196 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.