Prov 205 LLC
NPI 1063963411 · Psychologist · Bayonne, NJ
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Prov 205 LLC is a Psychologist organization in Bayonne, NJ (NPI 1063963411).
Provider details
- NPI number
- 1063963411
- Entity type
- Organization
- Primary specialty
- PsychologistBehavioral Health & Social Service Providers
- Organization subpart
- No
- Authorized official
- Joel Nunez, Psychologist(201) 455-2052
- License
- 35SI00437200 (NJ)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2016-10-20
- Last updated
- 2017-04-27
Frequently asked questions
- What is Prov 205 LLC's NPI number?
- Prov 205 LLC's National Provider Identifier (NPI) is 1063963411, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Prov 205 LLC?
- Prov 205 LLC is classified in the NPPES registry as Psychologist (Behavioral Health & Social Service Providers).
- Where is Prov 205 LLC located?
- Prov 205 LLC's practice location on file with NPPES is 866 Broadway, Bayonne, NJ 07002-3070.
- What is Prov 205 LLC's phone number?
- The practice phone number listed in the NPPES registry for Prov 205 LLC is (201) 455-2052.
- Does Prov 205 LLC accept Medicare?
- Prov 205 LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Prov 205 LLC?
- The authorized official listed on Prov 205 LLC's NPPES record is Joel Nunez, Psychologist. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Prov 205 LLC's NPI active?
- Yes — Prov 205 LLC's NPI (1063963411) is active in the NPPES registry as of the last update on 2017-04-27.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.