MEDICARE: CEREBRAL PALSY OF NORTH JERSEY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2	343800000X	Secured Medical Transport (VAN)
3	385H00000X	Respite Care
4	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558983213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEREBRAL PALSY OF NORTH JERSEY, INC.

Provider Business Mailing Address
First Line	:	220 S ORANGE AVE
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-5804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 COLGATE DRIVE
Second Line	:
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960
Country	:	US
Telephone Number	:	973-763-9900
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICIER
Name	:	MR. HASSAN FARHAN
Credential	:
Telephone Number	:	973-821-8107

Provider Enumeration Date	:	05/15/2020
Last Update Date	:	05/15/2020

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