Basic Information
| Provider Information | |||||||||
| NPI: | 1457719460 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAYNE BEHAVIORAL SERVICE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 HAMBURG TPKE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074702154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737909222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 HAMBURG TURNPIKE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737909222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2016 | ||||||||
| LastUpdateDate: | 02/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | ELRAFEI | ||||||||
| AuthorizedOfficialFirstName: | MOHAMED | ||||||||
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| AuthorizedOfficialTitleorPosition: | PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 9737909222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | TP# 153-079 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.