Healthcare Provider Details

I. General information

NPI: 1518033257
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF CENTRAL AND GREATER NORTHERN NJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 PARK AVENUE
PLAINFIELD NJ
07060
US

IV. Provider business mailing address

196 SPEEDWELL AVENUE
MORRISTOWN NJ
07960
US

V. Phone/Fax

Practice location:
  • Phone: 908-756-3736
  • Fax: 908-756-9272
Mailing address:
  • Phone: 973-539-9580
  • Fax: 973-539-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberD06615806
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number31D0111811
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier0045764
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: CAROLYN LALLY
Title or Position: DIRECTOR OF BILLING AND REVENUE C
Credential:
Phone: 973-539-9580