- Practice location
- 510 Broadway, Bayonne, NJ 07002-3712
- Phone
- 201-455-2052
- Fax
- 201-354-9376
- Last updated
- November 12, 2026
Prov 205 LLC is a healthcare organization based in Bayonne, NJ. Prov 205 LLC practices in Bayonne, NJ. The NPI Number for Prov 205 LLC is 1063963411 and holds a License No. 35SI00437200 (NJ). The current practice location address for Prov 205 LLC is 510 Broadway, Bayonne, NJ 07002-3712 and can be reached out via phone at 201-455-2052 and via fax at 201-354-9376.
Provider Profile Details
- NPI Number
- 1063963411
- Provider Name
- Prov 205 LLC
- Provider Entity Type
- Organization
- Address
- 510 Broadway, Bayonne, NJ 07002-3712
- Phone Number
- 201-455-2052
- Fax Number
- 201-354-9376
- Primary Taxonomy
- Psychologist · 103T00000X
- Organization Subpart
- No
- Authorized Official
- Dr. Joel Nunez, PHD · Psychologist · 201-455-2052
- Provider Enumeration Date
- October 20, 2016
- Last Update Date
- November 12, 2026
- Certification Date
- November 12, 2026
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 510 Broadway
Bayonne, NJ 07002-3712 - City
- Bayonne
- State
- New Jersey
- Zip
- 07002-3712
- Phone Number
- 201-455-2052
- Fax Number
- 201-354-9376
Provider Business Mailing Address Details
- Address
- Po Box 626
New Providence, NJ 07974-0626 - City
- New Providence
- State
- NJ
- Zip
- 07974-0626
- Phone Number
- 201-455-2052
- Fax Number
- 201-354-9376
License Information
- License Number
- 35SI00437200
- License State
- NJ
- Taxonomy
- Psychologist · 103T00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Prov 205 LLC?
The NPI number of Prov 205 LLC is 1063963411. It was assigned on October 20, 2016 and is currently active in the NPPES registry.
What is the specialty of Prov 205 LLC?
Prov 205 LLC is registered under the primary taxonomy Psychologist (code 103T00000X), licensed in NJ under license number 35SI00437200.
Where does Prov 205 LLC practice?
The practice location is 510 Broadway, Bayonne, NJ 07002-3712. The office can be reached at 201-455-2052 (phone) or 201-354-9376 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1063963411 directly on the NPPES registry website.