NPIMap

Organization Active NPI

Fairlawn Behavioral Associates LLC

  • Prescribing (Medical) Psychologist
  • Fair Lawn, NJ
National Provider Identifier
1861876419
Registry record updated Jul 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prescribing (Medical) PsychologistTaxonomy code 103TP0016X
License
25MA6506500 Issued in NJ
Legal business name
FAIRLAWN BEHAVIORAL ASSOCIATES LLC
Practice address
15-01 Broadway
Suite# 10B
Fair Lawn, NJ 07410-6003
Phone
(201) 342-4004
Fax
(201) 342-4008
NPI assigned
Jul 14, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2015

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

Authorized official

Name
Mr. Mohsan Jan
Title
Administartor
Phone
(201) 289-8455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prescribing (Medical) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP0016X 25MA6506500 NJ Primary

Addresses

Primary practice location

15-01 Broadway
Suite# 10B
Fair Lawn, NJ 07410-6003

Mailing address

PO Box 809
Teaneck, NJ 07666-0809
Phone (201) 342-4004

Other identifiers 1

IdentifierTypeStateIssuer
7492201MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150825005651 NJ Part B Supplier - Clinic/Group Practice 9638485329 Receives reassigned benefits from 12 practitioners
Practice locations: Fair Lawn, NJ

National Provider Directory

National Provider Directory
Tax ID family
Fairlawn Behavioral Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

15-01 Broadway
Ste 6
Fair Lawn, NJ 07410

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1436832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436832000000",
    "number": "1861876419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 809",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076660809",
            "telephone_number": "201-342-4004",
            "fax_number": "201-243-7874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15-01 BROADWAY",
            "address_2": "SUITE# 10B",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074106003",
            "telephone_number": "201-342-4004",
            "fax_number": "201-342-4008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRLAWN BEHAVIORAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-14",
        "last_updated": "2015-07-14",
        "status": "A",
        "authorized_official_last_name": "JAN",
        "authorized_official_first_name": "MOHSAN",
        "authorized_official_title_or_position": "ADMINISTARTOR",
        "authorized_official_telephone_number": "201-289-8455",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "NJ",
            "license": "25MA6506500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7492201",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fair Lawn, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; 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.