Provider Demographics
NPI:1053971572
Name:MIDDLESEX PSYCHIATRY & TMS PC
Entity type:Organization
Organization Name:MIDDLESEX PSYCHIATRY & TMS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELISIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-413-8020
Mailing Address - Street 1:165 PASSAIC AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1580
Mailing Address - Country:US
Mailing Address - Phone:800-413-8020
Mailing Address - Fax:
Practice Address - Street 1:165 PASSAIC AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1580
Practice Address - Country:US
Practice Address - Phone:800-413-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)