Basic Information
| Provider Information | |||||||||
| NPI: | 1407950140 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JERSEY SHORE UNIVERSITY MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MERIDIAN BEHAVIORAL HEALTH | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 WILLOW AVE | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077312507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327764081 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1945 STATE ROUTE 33 | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077534859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327764081 | ||||||||
| FaxNumber: | 7327762329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | METTA | ||||||||
| AuthorizedOfficialFirstName: | CATHY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ASST NS MGR | ||||||||
| AuthorizedOfficialTelephone: | 7327764081 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RNC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 26NO05915400 | NJ | Y | Hospitals | General Acute Care Hospital |
No ID Information.