| First Choice Recovery Center Pc | |
|
61 N Maple Ave Ste 302 Ridgewood NJ 07450-3232 | |
| (201) 956-9483 | |
| (201) 288-5262 |
| Full Name | First Choice Recovery Center Pc |
|---|---|
| Speciality | Psychologist |
| Location | 61 N Maple Ave Ste 302, Ridgewood, New Jersey |
| Authorized Official Name and Position | Manoj Puthiyathu (OWNER) |
| Authorized Official Contact | 2019569483 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| First Choice Recovery Center Pc 61 N Maple Ave Ste 302 Ridgewood NJ 07450-3232 Ph: (201) 956-9483 | First Choice Recovery Center Pc 61 N Maple Ave Ste 302 Ridgewood NJ 07450-3232 Ph: (201) 956-9483 |
| NPI Number | 1962071910 |
|---|---|
| Provider Enumeration Date | 06/23/2021 |
| Last Update Date | 06/23/2021 |
| Certification Date | 06/22/2021 |
| Medicare PECOS PAC ID | 7911300561 |
|---|---|
| Medicare Enrollment ID | O20210720003961 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962071910 | NPI | - | NPPES |
| 25MA09523700 | Other | NJ | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| Provider Name | Manoj Puthiyathu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649408956 PECOS PAC ID: 7416279617 Enrollment ID: I20141125000429 |
| Provider Name | Althea Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063977114 PECOS PAC ID: 4688905516 Enrollment ID: I20191008001348 |
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