Basic Information
| Provider Information | |||||||||
| NPI: | 1780994343 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAMILTON MEDICALLY ASSISTED TREATMENT ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1777 KLOCKNER ROAD | ||||||||
| Address2: | SUITE #: 1 | ||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009900340 | ||||||||
| FaxNumber: | 9543370364 | ||||||||
| Practice Location | |||||||||
| Address1: | 1777 KLOCKNER ROAD | ||||||||
| Address2: | SUITE #: 1 | ||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009900340 | ||||||||
| FaxNumber: | 9543370364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2010 | ||||||||
| LastUpdateDate: | 05/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | ZAYAS | ||||||||
| AuthorizedOfficialFirstName: | JENNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8009900340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 103TP2701X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.