Provider Demographics
NPI:1124848056
Name:VINEYARD PSYCHIATRY
Entity type:Organization
Organization Name:VINEYARD PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROLL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:646-831-1227
Mailing Address - Street 1:5 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-1931
Mailing Address - Country:US
Mailing Address - Phone:646-831-1227
Mailing Address - Fax:
Practice Address - Street 1:123 N UNION AVE STE 302
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2198
Practice Address - Country:US
Practice Address - Phone:908-738-9185
Practice Address - Fax:908-282-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty