Provider Demographics
NPI:1568293066
Name:MEDICA MENTAL HEALTH
Entity type:Organization
Organization Name:MEDICA MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:201-316-5581
Mailing Address - Street 1:PO BOX 2507
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-8407
Mailing Address - Country:US
Mailing Address - Phone:201-316-5581
Mailing Address - Fax:201-977-2889
Practice Address - Street 1:162 E ROUTE 59
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2910
Practice Address - Country:US
Practice Address - Phone:201-316-5581
Practice Address - Fax:201-977-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty