Healthcare Provider Details

I. General information

NPI: 1639615511
Provider Name (Legal Business Name): TOWNSHIP OF LYNDHURST/PARKS DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 FERN AVE 1ST FLOOR
LYNDHURST NJ
07071-2252
US

IV. Provider business mailing address

250 CLEVELAND AVE
LYNDHURST NJ
07071-1902
US

V. Phone/Fax

Practice location:
  • Phone: 201-372-1135
  • Fax: 201-372-0225
Mailing address:
  • Phone: 201-804-2482
  • Fax: 201-939-6153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS KELLY ANN KEENAN
Title or Position: WORKSHOP DIRECTOR
Credential:
Phone: 201-372-1135