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General NPI Number Information
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NPI Number | 1649496993
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Entity Type | Organization
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Legal Business Name | EASTER SEALS NEW JERSEY
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 121 MAIN ST
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City | WEST ORANGE
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State | NJ
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Zip | 07052-5673
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Country | US
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Telephone | 732-257-6662
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Fax | 732-257-7373
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Provider Business Mailing Address
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Address Line | 241 FORSGATE DRIVE
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City | JAMESBURG
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State | NJ
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Zip | 08831
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Country | US
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Telephone | 732-257-6662
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Fax | 732-257-7373
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Authorized Official
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Title or Position | VP OF REVENUE
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Name | OMAR SOBERAL
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Credential |
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Telephone | 732-955-8373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MONMOUTH CM
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License Number State | NJ
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