Provider Demographics
NPI:1215216361
Name:BRIDGEWAY BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:BRIDGEWAY BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING & REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-355-7886
Mailing Address - Street 1:373 CLERMONT TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8073
Mailing Address - Country:US
Mailing Address - Phone:908-355-7886
Mailing Address - Fax:908-248-9376
Practice Address - Street 1:720 KING GEORGE RD
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-1974
Practice Address - Country:US
Practice Address - Phone:732-771-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ204010248251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0266515Medicaid