Basic Information
| Provider Information | |||||||||
| NPI: | 1891818407 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL JERSEY BEHAVIORAL HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 HOLLY ST | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | CRANFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070162158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082727500 | ||||||||
| FaxNumber: | 9082727502 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 HOLLY ST | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | CRANFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070162158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082727500 | ||||||||
| FaxNumber: | 9082727502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHU | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 9082727500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MA03739300 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.