Provider Demographics
NPI:1043496102
Name:TOWNSHIP OF SOUTH ORANGE VILLAGE
Entity Type:Organization
Organization Name:TOWNSHIP OF SOUTH ORANGE VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FESTA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:973-378-7715
Mailing Address - Street 1:101 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1901
Mailing Address - Country:US
Mailing Address - Phone:973-378-7715
Mailing Address - Fax:973-378-5830
Practice Address - Street 1:5 MEAD ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1501
Practice Address - Country:US
Practice Address - Phone:973-378-7715
Practice Address - Fax:973-378-5830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ468679Medicare PIN