MEDICARE: NORTH JERSEY COMMUNITY RESEARCH INITIATIVE

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	101Y00000X	Counselor
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1639371446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH JERSEY COMMUNITY RESEARCH INITIATIVE

Provider Business Mailing Address
First Line	:	393 CENTRAL AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2842
Country	:	US
Telephone Number	:	973-483-3444
Fax Number	:	973-485-7080

Provider Business Practice Location Address
First Line	:	393 CENTRAL AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2842
Country	:	US
Telephone Number	:	973-483-3444
Fax Number	:	973-485-7080

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	MR. CUTHBERT EMILE ASHBY
Credential	:
Telephone Number	:	973-483-3444

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	09/11/2025

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