Organization
FIRST CHOICE RECOVERY CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANOJ PUTHIYATHU MD (OWNER)
(201) 956-9483
Entity
Organization
Contact information
Practice address
61 N MAPLE AVE STE 302, RIDGEWOOD, NJ 07450-3232
(201) 956-9483
(201) 288-5262
Mailing address
61 N MAPLE AVE STE 302, RIDGEWOOD, NJ 07450-3232
(201) 956-9483
(201) 288-5262
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA09523700
STATE LICENSE
NJ
Enumeration date
06/23/2021
Last updated
06/23/2021
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