1285149740 NPI number — JEWISH SERVICE FOR THE DEVELOPMENTALLY DISABLED OF METROWEST, INC.

Table of content: (NPI 1285149740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285149740 NPI number — JEWISH SERVICE FOR THE DEVELOPMENTALLY DISABLED OF METROWEST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEWISH SERVICE FOR THE DEVELOPMENTALLY DISABLED OF METROWEST, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285149740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 EISENHOWER PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07039-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-272-7141
Provider Business Mailing Address Fax Number:
973-992-1509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 WEDGEWOOD DR APT 122
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERONA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07044-4129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-272-7141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PRESS
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
973-272-7141

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: GH1419 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8862397 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com