Provider Demographics
NPI:1033584347
Name:KELSCH AT WOODBURY ATS
Entity Type:Organization
Organization Name:KELSCH AT WOODBURY ATS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:856-456-2022
Mailing Address - Street 1:19 E CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2415
Mailing Address - Country:US
Mailing Address - Phone:856-853-9996
Mailing Address - Fax:856-853-0909
Practice Address - Street 1:19 E CENTRE ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-2415
Practice Address - Country:US
Practice Address - Phone:856-853-9996
Practice Address - Fax:856-853-0909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KELSCH ASSOCIATES NJ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-11
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========Medicaid