MEDICARE: CATHOLIC CHARITIES OF THE ARCHDIOCESE OF NEWARK

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	302R00000X	Health Maintenance Organization	44SL05852700	NJ

General Provider Information

NPI Number	:	1821429010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC CHARITIES OF THE ARCHDIOCESE OF NEWARK

Provider Business Mailing Address
First Line	:	182 LAUREL AVE
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-1331
Country	:	US
Telephone Number	:	973-931-0750
Fax Number	:

Provider Business Practice Location Address
First Line	:	182 LAUREL AVE
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-1331
Country	:	US
Telephone Number	:	973-931-0750
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	SHELLEY STEINBERG
Credential	:	LCSW
Telephone Number	:	973-266-7983

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	12/12/2013

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