Organization
ST MARY'S HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PERRY IASELLO LCSW (ED)
(973) 470-3056
Entity
Organization
Contact information
Practice address
350 MAIN AVE, PASSAIC, NJ 07055
(973) 470-3056
Mailing address
350 MAIN AVE, PASSAIC, NJ 07055
(973) 470-3056
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
37LC00086000
NJ
Other
Enumeration date
05/21/2014
Last updated
05/21/2014
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