Provider Demographics
NPI:1124072632
Name:IMMEDIATE CARE PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:IMMEDIATE CARE PSYCHIATRIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ICPC
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-335-9909
Mailing Address - Street 1:28 HILL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1001
Mailing Address - Country:US
Mailing Address - Phone:973-335-9909
Mailing Address - Fax:973-335-9910
Practice Address - Street 1:28 HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1001
Practice Address - Country:US
Practice Address - Phone:973-335-9909
Practice Address - Fax:973-335-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X, 163WP0809X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ058035Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER