Healthcare Provider Details

I. General information

NPI: 1417482050
Provider Name (Legal Business Name): JEWISH SERVICE FOR THE DEVELOPMENTALLY DISABLED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 EISENHOWER PKWY
LIVINGSTON NJ
07039-1708
US

IV. Provider business mailing address

622 EAGLE ROCK AVE
WEST ORANGE NJ
07052-2994
US

V. Phone/Fax

Practice location:
  • Phone: 973-272-7141
  • Fax: 973-992-1509
Mailing address:
  • Phone: 973-272-7141
  • Fax: 973-325-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. LINDA PRESS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-272-7141