Basic Information
| Provider Information | |||||||||
| NPI: | 1821063835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENAFLY PSYCHIATRIC ASSOCIATES, L.L.C. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2 DEAN DR FL 1 | ||||||||
| Address2: | |||||||||
| City: | TENAFLY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076702765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015688288 | ||||||||
| FaxNumber: | 2015688105 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 DEAN DRIVE | ||||||||
| Address2: | 1ST FLOOR SOUTH WING | ||||||||
| City: | TENAFLY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076702765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015688288 | ||||||||
| FaxNumber: | 2015688105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | FRIEDMAN | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2013147648 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 9055509 | 05 | NJ | MEDICAID |