MEDICARE: COUNTY OF ESSEX

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	:	1598972549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF ESSEX

Provider Business Mailing Address
First Line	:	50 S CLINTON ST
Second Line	:	SUITE 3240
City	:	EAST ORANGE
State	:	NJ
Zip	:	07018-3120
Country	:	US
Telephone Number	:	973-395-8375
Fax Number	:	973-395-8309

Provider Business Practice Location Address
First Line	:	50 S CLINTON ST
Second Line	:	SUITE 3240
City	:	EAST ORANGE
State	:	NJ
Zip	:	07018-3120
Country	:	US
Telephone Number	:	973-395-8375
Fax Number	:	973-395-8309

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JACKLYN DEVORE
Credential	:
Telephone Number	:	973-395-8375

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/02/2009

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Directions to “COUNTY OF ESSEX ” Practice Location

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