Unknown Individual – Psychiatry Physician, NPI 1255445128

Unknown Individual is a healthcare provider. based in Montville, New Jersey. specializing in Psychiatry Physician. They hold a License No. 25MA06474300 (NJ). The NPI Number for Unknown Individual is 1255445128

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1255445128
Phone
(973) 439-6999
Address
170 CHANGEBRIDGE RD BLDG B34
Deactivation Date
16 June 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9085227000
Graduation Year
1983 (43 years ago)
PAC ID
1254340391
Group Practice PAC ID
8628047685
Professional Enrollment ID
I20060418000302
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 170 CHANGEBRIDGE RD BLDG B34

    MONTVILLE, NJ 070459114

    Phone: (973) 439-6999

    Fax: (973) 439-1999

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 07045)

Loading plans...

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8628047685View full group profile
NameSpecialtyState
Nurse PractitionerNJ
Nurse PractitionerNJ
P S Y C H I A T R YPA
Psychiatry, Geriatric PsychiatryNJ
Internal Medicine, Infectious DiseaseNJ
Nurse PractitionerNJ
P S Y C H I A T R YNJ
Nurse PractitionerNJ
P S Y C H I A T R YNJ
P S Y C H I A T R YNJ

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1255445128.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What kind of provider is Unknown Individual?
The page reflects Psychiatry Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Montville, New Jersey because that is what the record indicates for Unknown Individual.
What if Montville, New Jersey seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

Similar Providers

DR. ROBERTO L CAGA-ANAN (MD)

Psychiatry Physician
390, Main Road, Towaco, Montville Township, Morris County, New Jersey, 07045, United States
NPI: 1932192168

DR. NORMA BORJA TALBO (MD)

Psychiatry Physician
390, Main Road, Towaco, Montville Township, Morris County, New Jersey, 07045, United States
NPI: 1316097918

DR. MARY KANNANKERIL

Psychiatry Physician
170, Changebridge Road, Montville Township, Morris County, New Jersey, 07045, United States
NPI: 1629115126

DR. VALERIE SYLVIA VERDE (MD)

Psychiatry Physician
390 MAIN RD
NPI: 1902936032

MARY C KANNANKERIL MD.,PA

Psychiatry Physician
170 CHANGEBRIDGE RD
NPI: 1538406574

DR. DEVESH JALAN (MD)

Psychiatry Physician
2800 Main St
NPI: 1083092134