Provider Demographics
NPI:1992941561
Name:ACCESS PSYCHIATRIC AND BEHAVIORAL SERVICES.
Entity type:Organization
Organization Name:ACCESS PSYCHIATRIC AND BEHAVIORAL SERVICES.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANFRED
Authorized Official - Middle Name:KANU
Authorized Official - Last Name:OBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-951-0653
Mailing Address - Street 1:PO BOX 5087
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-5087
Mailing Address - Country:US
Mailing Address - Phone:973-951-0653
Mailing Address - Fax:908-469-2135
Practice Address - Street 1:1235 MORRIS AVE STE 1
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3344
Practice Address - Country:US
Practice Address - Phone:908-258-7759
Practice Address - Fax:908-469-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-01
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400263786261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)