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AVICENNA MEDICAL CENTER NPI 1073904801


NPI Information

NPI: 1073904801
Provider Name: AVICENNA MEDICAL CENTER
Classification: Psychologist - 103TP0016X
Entity Type: Organization

Specialization: Prescribing (Medical)

Address:
129 VALLEY RD
2ND FLOOR
MONTCLAIR, NJ
ZIP 07042
Phone: (973) 746-2620
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AVICENNA MEDICAL CENTER is a prescribing (medical) psychologist in Montclair, NJ. The provider is a licensed, doctoral-level psychologist authorized to prescribe and has undergone specialized education and training in preparation for prescriptive practice and has passed an examination accepted by the state board of psychology relevant to establishing competence for prescribing, and has received from the state board of psychology a current certificate granting prescriptive authority, which has not been revoked or suspended. AVICENNA MEDICAL CENTER NPI is 1073904801. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

129 VALLEY RD
2ND FLOOR
MONTCLAIR, NJ
ZIP 07042-331
Phone: (973) 746-2620
Fax: (973) 746-2579

The provider's authorized official is Anna Michele Rossi .
The authorized official title is President/psychiatrist and has the following contact phone number (973) 746-2620.

The enumeration date for this NPI number is 2/16/2015 and was last updated on 2/16/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TP0016XPsychologistPrescribing (Medical)25MB07627000NEW JERSEYYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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