Healthcare Provider Details

I. General information

NPI: 1306226063
Provider Name (Legal Business Name): EASTER SEALS NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MANCHESTER AVEENUE; UNIT 10 OAKFIELD PLAZA
FORKED RIVER NJ
08731
US

IV. Provider business mailing address

25 KENNEDY BLVD SUITE 600
EAST BRUNSWICK NJ
08816-1259
US

V. Phone/Fax

Practice location:
  • Phone: 609-693-1398
  • Fax: 609-693-5197
Mailing address:
  • Phone: 732-257-6662
  • Fax: 732-257-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN J FITZGERALD
Title or Position: PRESIDENT
Credential:
Phone: 732-257-6662