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NPI Code Detail

MEDICARE: CENTER FOR FAMILY SUPPORT, NEW JERSEY, INC.

MEDICARE: CENTER FOR FAMILY SUPPORT, NEW JERSEY, INC.
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
1251C00000XDevelopmentally Disabled Services Day Training Agency

General Provider Information

NPI Number : 1720463193
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTER FOR FAMILY SUPPORT, NEW JERSEY, INC.
Provider Business Mailing Address
First Line : 333 7TH AVE FL 9
Second Line :
City : NEW YORK
State : NY
Zip : 10001-5004
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 333 7TH AVE FL 9
Second Line :
City : NEW YORK
State : NY
Zip : 10001-5004
Country : US
Telephone Number : 212-629-7939
Fax Number :
Authorized Official
Title or Position : ASST EXECUTIVE DIRECTOR
Name : MICHAEL MAZZOCCO
Credential :
Telephone Number : 212-629-7939
Provider Enumeration Date : 07/27/2015
Last Update Date : 07/27/2015

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Directions to “CENTER FOR FAMILY SUPPORT, NEW JERSEY, INC. ” Practice Location

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