Provider Demographics
NPI: | 1538807011 |
---|---|
Name: | INSITE MEDICAL NJ PA |
Entity type: | Organization |
Organization Name: | INSITE MEDICAL NJ PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | VP OF OPERATIONS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JULIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GILLIAM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 833-494-6724 |
Mailing Address - Street 1: | 525 ROUTE 73 N STE 302 |
Mailing Address - Street 2: | |
Mailing Address - City: | MARLTON |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08053-3422 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 833-494-6724 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 525 ROUTE 73 N STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | MARLTON |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08053-3422 |
Practice Address - Country: | US |
Practice Address - Phone: | 833-494-6724 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-05-24 |
Last Update Date: | 2025-04-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
No | 364SP0810X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Family | Group - Multi-Specialty |