1053667584 NPI number — NEWBRIDGE SERVICES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053667584 NPI number — NEWBRIDGE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWBRIDGE SERVICES, 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:
1053667584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 NEWARK POMPTON TPKE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMPTON PLAINS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07444-1792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-839-2520
Provider Business Mailing Address Fax Number:
973-686-2240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1069 RINGWOOD AVE STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WANAQUE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-831-0613
Provider Business Practice Location Address Fax Number:
973-831-0957
Provider Enumeration Date:
08/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BORDEN
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
973-686-2225

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  30304-12-04 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1053667584 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7679700 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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