Basic Information
| Provider Information | |||||||||
| NPI: | 1346467727 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW STREET TREATMENT ASSOCATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 NEW ST | ||||||||
| Address2: | |||||||||
| City: | IRVINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071112444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733732010 | ||||||||
| FaxNumber: | 9733731245 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 NEW ST | ||||||||
| Address2: | |||||||||
| City: | IRVINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071112444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733732010 | ||||||||
| FaxNumber: | 9733731245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RAMOS | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9793732010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | 2000004 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
ID Information
| ID | Type | State | Issuer | Description | 0055859 | 05 | NJ | MEDICAID |