Provider Demographics
NPI:1992521496
Name:AMITY CENTER FOR MENTAL HEALTH
Entity type:Organization
Organization Name:AMITY CENTER FOR MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DR.OLUFUNMILAYO
Authorized Official - Middle Name:O
Authorized Official - Last Name:ILORI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:973-580-1497
Mailing Address - Street 1:2 SUSAN CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-3761
Mailing Address - Country:US
Mailing Address - Phone:973-580-1497
Mailing Address - Fax:
Practice Address - Street 1:936 STUYVESANT AVE STE 1
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6998
Practice Address - Country:US
Practice Address - Phone:973-580-1497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty