Prov 205 LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

35SI00437200 Issued in NJ

Legal business name

PROV 205 LLC

Practice address

866 Broadway
Suite a
Bayonne, NJ 07002-3070

Phone

(201) 455-2052

Fax

(201) 354-9376

NPI assigned

Oct 20, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Joel Nunez, PH.D.NPI 1376862235

Title

Psychologist

Phone

(201) 455-2052

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joel Nunez, PH.D

  • Psychologist
  • Bayonne, NJ
  • NPI 1376862235
  Medicare reassignment NPD Authorized official
• Edith Olivo, PSY.D.

  • Clinical Psychologist
  • Bayonne, NJ
  • NPI 1548085657
  NPD
• Christopher Michael Thompson, PHD

  • Psychologist
  • Montclair, NJ
  • NPI 1871124669
  NPD (past)
• Deyanira Veloznunez, M.ED., M.A., ED.S.

  • Professional Counselor
  • Bayonne, NJ
  • NPI 1841114063
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493251200000",
    "number": "1063963411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 626",
            "city": "NEW PROVIDENCE",
            "state": "NJ",
            "postal_code": "079740626",
            "telephone_number": "201-455-2052",
            "fax_number": "201-354-9376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "866 BROADWAY",
            "address_2": "SUITE A",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070023070",
            "telephone_number": "201-455-2052",
            "fax_number": "201-354-9376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROV 205 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-20",
        "last_updated": "2017-04-27",
        "status": "A",
        "authorized_official_last_name": "NUNEZ",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "201-455-2052",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "35SI00437200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Bayonne, NJ
• Providers in Bayonne, NJ by specialty
• Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.