1457385700 NPI number — JEWISH FAMILY SERVICE & CHILDREN'S CENTER OF CLIFTON/PASSAIC, INC.

Table of content: (NPI 1457385700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457385700 NPI number — JEWISH FAMILY SERVICE & CHILDREN'S CENTER OF CLIFTON/PASSAIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEWISH FAMILY SERVICE & CHILDREN'S CENTER OF CLIFTON/PASSAIC, 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:
JEWISH FAMILY SERVICE
Provider Other Organization Name Type Code:
3
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:
1457385700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 MAIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASSAIC
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07055-4427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-777-7638
Provider Business Mailing Address Fax Number:
973-777-9311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 MAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASSAIC
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07055-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-777-7638
Provider Business Practice Location Address Fax Number:
973-777-9311
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERZOG
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
973-777-7638

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SC06729 , 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: 5857712 . This is a "AETAN GROUP ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: G434928 . This is a "OXFORD GROUP ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 205038 . This is a "MHN GROUP ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0263184 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145803 000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2021541 . This is a "CIGNA (GROUP ID)" identifier . This identifiers is of the category "OTHER".




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