1154856219 NPI number — NEW JERSEY INSTITUTE FOR DISABILITIES, INC

Table of content: (NPI 1154856219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154856219 NPI number — NEW JERSEY INSTITUTE FOR DISABILITIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW JERSEY INSTITUTE FOR DISABILITIES, 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:
6
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:
1154856219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10A OAK DR
Provider Second Line Business Mailing Address:
ROOSEVELT PARK
Provider Business Mailing Address City Name:
EDISON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08837-2313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-549-6187
Provider Business Mailing Address Fax Number:
732-590-2431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 AVONDALE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07747-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-549-6187
Provider Business Practice Location Address Fax Number:
732-590-2431
Provider Enumeration Date:
04/26/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FERRARA
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
732-549-6187

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  GH623 , 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: 0463477 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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