Organization
FAIRLAWN BEHAVIORAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOHSAN JAN (ADMINISTARTOR)
(201) 289-8455
Entity
Organization
Contact information
Practice address
15-01 BROADWAY, SUITE# 10B, FAIR LAWN, NJ 07410-6003
(201) 342-4004
(201) 342-4008
Mailing address
PO BOX 809, TEANECK, NJ 07666-0809
(201) 342-4004
(201) 243-7874
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
25MA6506500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7492201
—
NJ
Enumeration date
07/14/2015
Last updated
07/14/2015
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