Psychiatric Medicine Consultants of New Jersey LLC

Primary specialty

Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X

License

25MA07660500 Issued in NJ

Legal business name

PSYCHIATRIC MEDICINE CONSULTANTS OF NEW JERSEY LLC

Practice address

60 W Ridgewood Ave
Ridgewood, NJ 07450-3197

Phone

(201) 681-2915

NPI assigned

Aug 5, 2007

Organization subpart

No

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

Authorized official

Name

Steven C Samuels, MD

Title

President

Phone

(201) 681-2915

Specialties & licenses 1

Addresses

Practitioners 1

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

• Charles W. Park, M.D.

  • Psychiatry Physician
  • West Orange, NJ
  • NPI 1629179411
  NPD (past)

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196208000000",
    "number": "1366633448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 W RIDGEWOOD AVE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503197",
            "telephone_number": "201-681-2915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 W RIDGEWOOD AVE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503197",
            "telephone_number": "201-681-2915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRIC MEDICINE CONSULTANTS OF NEW JERSEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2007-11-28",
        "status": "A",
        "authorized_official_last_name": "SAMUELS",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-681-2915",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "NJ",
            "license": "25MA07660500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Ridgewood, NJ by specialty
• Geriatric Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; 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.