Provider Demographics
NPI:1740093095
Name:PRESTON, MICHAEL ALEXANDER
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALEXANDER
Last Name:PRESTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-2116
Mailing Address - Country:US
Mailing Address - Phone:201-873-4056
Mailing Address - Fax:
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-2116
Practice Address - Country:US
Practice Address - Phone:201-873-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities