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FAIRLAWN BEHAVIORAL ASSOCIATES LLC NPI 1861876419


NPI Information

NPI: 1861876419
Provider Name: FAIRLAWN BEHAVIORAL ASSOCIATES LLC
Classification: Psychologist - 103TP0016X
Entity Type: Organization

Specialization: Prescribing (Medical)

Address:
15-01 BROADWAY
SUITE# 10B
FAIR LAWN, NJ
ZIP 07410
Phone: (201) 342-4004
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FAIRLAWN BEHAVIORAL ASSOCIATES LLC is a prescribing (medical) psychologist in Fair Lawn, 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has received from the state board of psychology a current certificate granting prescriptive authority, which has not been revoked or suspended. FAIRLAWN BEHAVIORAL ASSOCIATES LLC NPI is 1861876419. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

15-01 BROADWAY
SUITE# 10B
FAIR LAWN, NJ
ZIP 07410-003
Phone: (201) 342-4004
Fax: (201) 342-4008

The provider's authorized official is Mohsan Jan .
The authorized official title is Administartor and has the following contact phone number (201) 289-8455.

The enumeration date for this NPI number is 7/14/2015 and was last updated on 7/14/2015.


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)25MA6506500NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1073813MEDICARE PINNEW JERSEY
27492201MEDICAIDNEW JERSEY

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.