Healthcare Provider Details

I. General information

NPI: 1063894251
Provider Name (Legal Business Name): CENTER FOR FAMILY SUPPORT, NEW JERSEY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 ROBIN RD SUITE 122
PARAMUS NJ
07652-1449
US

IV. Provider business mailing address

333 7TH AVE FL 9
NEW YORK NY
10001-5004
US

V. Phone/Fax

Practice location:
  • Phone: 201-262-4021
  • Fax: 201-262-4047
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL MAZZOCCO
Title or Position: ASST EXECUTIVE DIRECTOR
Credential:
Phone: 212-629-7939