Healthcare Provider Details

I. General information

NPI: 1669185005
Provider Name (Legal Business Name): CEREBRAL PALSY OF NORTH JERSEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 12/30/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220-24 SALEM ROAD
PLAINFIELD NJ
07060
US

IV. Provider business mailing address

120 EAGLE ROCK AVE STE 290
EAST HANOVER NJ
07936-3168
US

V. Phone/Fax

Practice location:
  • Phone: 973-763-9900
  • Fax:
Mailing address:
  • Phone: 973-763-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0479268
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. DAVID BISHOP
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 973-821-8108