Basic Information
| Provider Information | |||||||||
| NPI: | 1376896290 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERIDIAN HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 JUMPING BROOK RD | ||||||||
| Address2: | BUILDING 5, SUITE 201-202 | ||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077532634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326434400 | ||||||||
| FaxNumber: | 7326434378 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 JUMPING BROOK RD | ||||||||
| Address2: | BUILDING 5, SUITE 201-202 | ||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077532634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326434400 | ||||||||
| FaxNumber: | 7326434378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2012 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | CHOSAK | ||||||||
| AuthorizedOfficialFirstName: | MALLORY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL THERAPIST II | ||||||||
| AuthorizedOfficialTelephone: | 7326434364 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S., LAC, NCC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 37AC00133800 | NJ | Y | Hospitals | General Acute Care Hospital |
No ID Information.