Prov 205 LLC
NPI 1063963411ActiveOrganization· Psychologist· Bayonne, NJ
Psychologist in Bayonne, New Jersey, registered in NPPES in October 2016. The authorized official on file is Joel Nunez, PH.D., Psychologist. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1063963411 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 20, 2016 |
| Last updated in NPPES | Apr 27, 2017 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist Primary | 103T00000X | 35SI00437200 | NJ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (NJ) |
|---|
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