Basic Information
Provider Information | |||||||||
NPI: | 1558409912 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NEW STREET TREATMENT ASSOCIATES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: | 02/01/2007 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RAMOS | ||||||||
AuthorizedOfficialFirstName: | JANET | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 9733732010 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RN | ||||||||
NPICertificationDate: |   |
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 | 0057177 | 05 | NJ |   | MEDICAID |