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NPI Code Detail

MEDICARE: DEVELOPMENTAL DISABILITIES HEALTH SERVICES PA

MEDICARE: DEVELOPMENTAL DISABILITIES HEALTH SERVICES PA
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
1174400000XSpecialistNJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417977257
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEVELOPMENTAL DISABILITIES HEALTH SERVICES PA
Provider Business Mailing Address
First Line : 1285 BROAD ST
Second Line :
City : BLOOMFIELD
State : NJ
Zip : 07003-3045
Country : US
Telephone Number : 973-338-4200
Fax Number : 973-338-4440
Provider Business Practice Location Address
First Line : 1285 BROAD ST
Second Line :
City : BLOOMFIELD
State : NJ
Zip : 07003-3045
Country : US
Telephone Number : 973-338-4200
Fax Number : 973-338-4440
Authorized Official
Title or Position : PRESIDENT
Name : DR. THEODORE ANDREW KASTNER
Credential : M.D., M. S.
Telephone Number : 973-338-4200
Provider Enumeration Date : 07/21/2006
Last Update Date : 06/17/2015

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Directions to “DEVELOPMENTAL DISABILITIES HEALTH SERVICES PA ” Practice Location

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