Healthcare Provider Details

I. General information

NPI: 1790166080
Provider Name (Legal Business Name): NORTH JERSEY FRIENDSHIP HOUSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 E RIDGEWOOD AVE
PARAMUS NJ
07652-4820
US

IV. Provider business mailing address

125 ATLANTIC ST
HACKENSACK NJ
07601-4135
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-2121
  • Fax: 201-488-7161
Mailing address:
  • Phone: 201-488-2121
  • Fax: 201-488-7161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number920090105
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier0512583
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DR. DINORAH D'AURIA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PSYD
Phone: 201-488-2121