KETAMINE TREATMENT CENTERS OF PRINCETON, LLC (NPI# 1679119994) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679119994 |
| Entity Type | Organization |
| Organization Name | KETAMINE TREATMENT CENTERS OF PRINCETON, LLC |
| Practice Address |
9800 Falls Rd Ste 105 Potomac MD 20854-3939 |
| Mailing Address |
800 Bunn Dr Ste 304 Princeton NJ 08540-1968 |
| Practice Telephone | 8885668774 |
| Mailing Telephone | 8885668774 |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2019-11-21 |
| Authorized Official Name | STEVEN P. LEVINE (MANAGING MEMBER) |
| Authorized Official Telephone | 6096514429 |
| Is Organization Subpart | Y |
| Parent Organization Name | KETAMINE TREATMENT CENTERS OF PRINCETON, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Actify Neurotherapies | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538705835 | Ketamine Treatment Centers of Princeton, LLC | Psychiatry & Neurology | 357 S Gulph Rd Ste 260, King of Prussia, PA 19406-3174 | 2019-11-21 |
| 1730725052 | Ketamine Treatment Centers of Princeton, LLC | Psychiatry & Neurology | 91 S Jefferson Rd Ste 301, Whippany, NJ 07981-1037 | 2019-11-21 |
| 1174169478 | Ketamine Treatment Centers of Princeton, LLC | Psychiatry & Neurology | 1122 Kenilworth Dr Ste 418, Towson, MD 21204-2148 | 2019-11-21 |
| 1114563434 | Ketamine Treatment Centers of Princeton, LLC | Psychiatry & Neurology | 1411 N Flagler Dr Ste 4700, West Palm Beach, FL 33401-3408 | 2019-11-21 |
| 1780174482 | Ketamine Treatment Centers of Princeton, LLC | Psychiatry & Neurology | 12 E 44th St Fl 6, New York, NY 10017-3624 | 2018-05-17 |
| 1609288604 | Ketamine Treatment Centers of Princeton, LLC | Psychiatry & Neurology | 800 Bunn Dr, Suite 304, Princeton, NJ 08540-1968 | 2014-05-24 |
| Street Address |
9800 FALLS RD STE 105 |
| City | POTOMAC |
| State | MD |
| Zip Code | 20854-3939 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750810032 | Zhen Zhao | Pathology | 10405 Democracy Ln, Potomac, MD 20854 | 2017-06-08 |
| 1821544602 | Candace Nuzzo Michiels | Speech-Language Pathologist | 11614 Seven Locks Road, Ivymount School, Rockville, MD 20854 | 2016-08-31 |
| 1790156131 | Navneet Dhaliwal | Dentist | 12620 Greenbriar Rd, Potomac, MD 20854 | 2015-10-12 |
| 1407276082 | Benjamin G Shapero | Psychologist | 7825 Tuckerman Ln Ste 209, Potomac, MD 20854 | 2014-04-22 |
| 1497192272 | Nadia Yusuf | Psychiatry & Neurology | 1201 Seven Locks Rd Ste 101, Rockville, MD 20854 | 2013-06-03 |
| 1669719480 | Bradlee Levine | Dentist | 7811 Montrose Rd. Suite 300, Potomac, MD 20854 | 2013-01-14 |
| 1609123199 | Marie Makandjo | Home Health Aide | 10532 Sunny Brook Ln, Potomac, MD 20854 | 2012-08-14 |
| 1902183262 | Viran Seneviratne | Pharmacist | 1597 Kimble Wick Road, Rockville, MD 20854 | 2011-11-14 |
| 1790083608 | Joy Hope Samuels-reid | Pediatrics | 8821 Bells Mill Rd, Potomac, MD 20854 | 2011-03-02 |
| 1386944429 | Margaret Z Treseler | Physical Therapist | Specialized Women's Physical Therapy, LLC, 7825 Tuckerman Lane, Suite 211, Potomac, MD 20854 | 2010-10-22 |
| Find all providers in zip 20854 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730421777 | Paul David Leber | Psychiatry & Neurology | 11909 Smoketree Rd, Potomac, MD 20854-3462 | 2013-03-16 |
| 1841509981 | Mihael H Polymeropoulos | Psychiatry & Neurology | 11300 Ridge Mist Ter, Potomac, MD 20854-7001 | 2010-10-06 |
| 1417198847 | Jay Norman Giedd | Psychiatry & Neurology | 12533 Grey Fox Ln, Potomac, MD 20854-1903 | 2009-03-14 |
| 1316195464 | Alan Brody | Psychiatry & Neurology | 11451 South Glen Road, Potomac, MD 20854 | 2008-09-03 |
| 1508013426 | Susan Diane Rich | Psychiatry & Neurology | 12640 Rolling Road, Potomac, MD 20854 | 2008-08-21 |
| 1730304312 | Charles Thomas Olsen | Psychiatry & Neurology | 10013 Sorrel Ave, Potomac, MD 20854-4748 | 2007-04-17 |
| 1548391246 | David Theodore George | Psychiatry & Neurology | 10400 Joiners Ln, Potomac, MD 20854-1941 | 2007-03-07 |
| 1346394426 | Bruce Paul Pfeffer | Psychiatry & Neurology | 9901 Glenolden Dr, Potomac, MD 20854-5004 | 2007-01-23 |
| 1417001462 | Sander Gary Genser | Psychiatry & Neurology | 8905 Wandering Trail Dr, Potomac, MD 20854-2379 | 2007-01-23 |
| 1427111335 | Noel Scott Howard | Psychiatry & Neurology | 8212 Buckspark Ln W, Potomac, MD 20854-4269 | 2006-12-19 |
| Find all providers in POTOMAC | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.