NPIMap

Organization Active NPI

Ketamine Treatment Centers of Princeton, LLC

  • Psychiatry Physician
  • Towson, MD
National Provider Identifier
1174169478
Registry record updated Nov 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
KETAMINE TREATMENT CENTERS OF PRINCETON, LLC
Practice address
1122 Kenilworth Dr Ste 418
Towson, MD 21204-2148
Phone
(888) 566-8774
NPI assigned
Nov 21, 2019
Organization subpart
Yes
Parent organization
KETAMINE TREATMENT CENTERS OF PRINCETON, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 21, 2019

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

Authorized official

Name
Steven P. LevineNPI 1477672913
Title
Managing Member
Phone
(609) 651-4429

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

1122 Kenilworth Dr Ste 418
Towson, MD 21204-2148

Mailing address

800 Bunn Dr Ste 304
Princeton, NJ 08540-1968
Phone (888) 566-8774

Other names 1

  • Actify Neurotherapies Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ketamine Treatment Centers of Princeton LLC5 organizations share this tax ID, including this one
Part of
Ketamine Treatment Centers of Princeton LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1122 Kenilworth Dr
Ste 418
Towson, MD 21204
Phone (410) 610-9135

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1574294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574294400000",
    "number": "1174169478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 BUNN DR STE 304",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085401968",
            "telephone_number": "888-566-8774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 KENILWORTH DR STE 418",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212042148",
            "telephone_number": "888-566-8774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE TREATMENT CENTERS OF PRINCETON, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KETAMINE TREATMENT CENTERS OF PRINCETON, LLC",
        "enumeration_date": "2019-11-21",
        "last_updated": "2019-11-21",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "609-651-4429"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Actify Neurotherapies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Towson, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.