Basic Information
| Provider Information | |||||||||
| NPI: | 1871920306 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY BEHAVIORAL HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 671 HOES LN W | ||||||||
| Address2: | |||||||||
| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088548021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322355900 | ||||||||
| FaxNumber: | 6093419380 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 WHITTLESEY RD | ||||||||
| Address2: | BATES BUILDING | ||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086183479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092924036 | ||||||||
| FaxNumber: | 6093419380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2013 | ||||||||
| LastUpdateDate: | 09/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | KOSSEFF | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 7322355900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 44SC00159200 | NJ | Y | Agencies | Community/Behavioral Health |
No ID Information.