Organization
BERGEN PSYCHIATRIC CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MINI THOMAS MBBS (CCRP)
(201) 956-9483
Entity
Organization
Contact information
Practice address
65 N MAPLE AVE STE 104, RIDGEWOOD, NJ 07450-3233
(201) 956-9483
(201) 288-5262
Mailing address
65 N MAPLE AVE STE 104, RIDGEWOOD, NJ 07450-3233
(201) 956-9483
(201) 288-5262
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA09523700
STATE LICENCE
NJ
Enumeration date
06/21/2017
Last updated
03/18/2019
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