Healthcare Provider Details

I. General information

NPI: 1639142938
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF METROPOLITAN NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 HAMBURG TPKE
POMPTON LAKES NJ
07442-1452
US

IV. Provider business mailing address

151 WASHINGTON ST
NEWARK NJ
07102-3026
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-2363
  • Fax: 973-839-5924
Mailing address:
  • Phone: 973-622-3900
  • Fax: 973-622-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number22623
License Number StateNJ

VIII. Authorized Official

Name: MS. DELORES TYSON
Title or Position: PRESIDENT/CEO
Credential: MA
Phone: 973-622-3900