Provider Demographics
NPI:1962760553
Name:PSYCHIATRY TO GO, LLC
Entity type:Organization
Organization Name:PSYCHIATRY TO GO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-536-9891
Mailing Address - Street 1:180 TUCKERTON RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055
Mailing Address - Country:US
Mailing Address - Phone:609-536-9890
Mailing Address - Fax:609-423-9060
Practice Address - Street 1:180 TUCKERTON RD
Practice Address - Street 2:SUITE 11
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8802
Practice Address - Country:US
Practice Address - Phone:609-536-9890
Practice Address - Fax:609-423-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty