MEDICARE: NEW JERSEY INSTITUTE FOR DISABILITIES INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency		NJ

General Provider Information

NPI Number	:	1932589116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW JERSEY INSTITUTE FOR DISABILITIES INC

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

Provider Business Practice Location Address
First Line	:	40 MARKLEY ST
Second Line	:
City	:	PORT READING
State	:	NJ
Zip	:	07064-1822
Country	:	US
Telephone Number	:	732-549-6187
Fax Number	:	732-590-2431

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ROBERT FERRARA
Credential	:
Telephone Number	:	732-549-6187

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	06/03/2015

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