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GENESIS ADDICTION AND BEHAVIORAL MEDICINE LLC NPI 1487141883


NPI Information

NPI: 1487141883
Provider Name: GENESIS ADDICTION AND BEHAVIORAL MEDICINE, LLC
Classification: Family Medicine - 207QA0401X
Entity Type: Organization

Specialization: Addiction Medicine

CLIA Number: 31D2147776

Address:
179 HIGH ST STE 101
NEWTON, NJ
ZIP 07860
Phone: (973) 862-4297
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GENESIS ADDICTION AND BEHAVIORAL MEDICINE, LLC is an addiction medicine family medicine in Newton, NJ. The provider is a family medicine physician who specializes in the diagnosis and treatment of addictions. GENESIS ADDICTION AND BEHAVIORAL MEDICINE, LLC NPI is 1487141883. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

179 HIGH ST STE 101
NEWTON, NJ
ZIP 07860-010
Phone: (973) 862-4297
Fax: (973) 327-7760

The provider's authorized official is Michael R. Ganon .
The authorized official title is Medical Director and has the following contact phone number (973) 862-4297.

The CLIA number assigned to this NPI record is 31D2147776 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/20/2018 and was last updated on 6/28/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207QA0401XFamily MedicineAddiction Medicine25MB05783900NEW JERSEYYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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