MEDICARE: DEVELOPMENTAL SERVICES OF NEW JERSEY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1194681312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVELOPMENTAL SERVICES OF NEW JERSEY, LLC

Provider Business Mailing Address
First Line	:	58 4TH ST
Second Line	:
City	:	PASSAIC
State	:	NJ
Zip	:	07055-7405
Country	:	US
Telephone Number	:	973-405-8859
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 4TH ST
Second Line	:
City	:	PASSAIC
State	:	NJ
Zip	:	07055-7405
Country	:	US
Telephone Number	:	973-405-8859
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACQUELINE ULLOA
Credential	:
Telephone Number	:	973-405-8859

Provider Enumeration Date	:	12/31/2025
Last Update Date	:	12/31/2025

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