Provider Demographics
NPI:1922897438
Name:AFFECT PROVIDER GROUP OF NEW JERSEY, P.C.
Entity type:Organization
Organization Name:AFFECT PROVIDER GROUP OF NEW JERSEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:ELWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-514-5420
Mailing Address - Street 1:116 N 3RD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1691
Mailing Address - Country:US
Mailing Address - Phone:845-769-8758
Mailing Address - Fax:
Practice Address - Street 1:44 APPLE ST STE 1
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-2672
Practice Address - Country:US
Practice Address - Phone:845-769-8758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health