{
"Npi": {
"NPI": "1669719654",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EASTER SEALS NEW JERSEY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "241 FORSGATE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JAMESBURG",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08831-1385",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-257-6662",
"MailingAddressFaxNumber": "732-257-7373",
"FirstLinePracticeLocationAddress": "959 ALEXANDRIA DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TOMS RIVER",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08753-2201",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "732-955-8374",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/10/2013",
"LastUpdateDate": "02/02/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SOBERAL",
"AuthorizedOfficialFirstName": "OMAR",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "VP OF REVENUE",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "732-955-8373",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}