Healthcare Provider Details

I. General information

NPI: 1023955630
Provider Name (Legal Business Name): NEW JERSEY DEVELOPMENTAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 TOWN SQUARE PL STE 1201
JERSEY CITY NJ
07310-1724
US

IV. Provider business mailing address

111 TOWN SQUARE PL STE 1201
JERSEY CITY NJ
07310-1724
US

V. Phone/Fax

Practice location:
  • Phone: 201-293-8220
  • Fax:
Mailing address:
  • Phone: 201-293-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: MIRIAM STEIN
Title or Position: MANAGING MEMBER
Credential:
Phone: 201-293-8220