Provider Demographics
NPI:1285090514
Name:PHOENIX BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:PHOENIX BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:URIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:609-771-3777
Mailing Address - Street 1:1014 WHITEHEAD ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2406
Mailing Address - Country:US
Mailing Address - Phone:609-771-3777
Mailing Address - Fax:
Practice Address - Street 1:1014 WHITEHEAD RD EXT
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-4132
Practice Address - Country:US
Practice Address - Phone:609-771-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOENIX BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-31
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)