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General NPI Number Information
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NPI Number | 1922388628
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Entity Type | Organization
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Legal Business Name | BRAIN INJURY RESOURCE GROUP
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 86 WALNUT VALLEY RD
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City | COLUMBIA
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State | NJ
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Zip | 07832-2789
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Country | US
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Telephone | 908-362-5862
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Fax |
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Provider Business Mailing Address
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Address Line | 86 WALNUT VALLEY RD
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City | COLUMBIA
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State | NJ
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Zip | 07832-2789
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Country | US
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Telephone | 908-362-5862
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Fax |
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Authorized Official
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Title or Position | CLINICAL COORDINATOR
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Name | JENNIFER ANN LISSITZ
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Credential | BA, ACBIS
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Telephone | 862-324-3456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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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 | 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 #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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