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 |