Provider Demographics
NPI:1083275804
Name:JAYSON WILLIAMS CENTER INC.
Entity Type:Organization
Organization Name:JAYSON WILLIAMS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOGTERP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-819-1594
Mailing Address - Street 1:98 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2208
Mailing Address - Country:US
Mailing Address - Phone:973-819-1594
Mailing Address - Fax:
Practice Address - Street 1:5499 N FEDERAL HWY STE GANDL2
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-4993
Practice Address - Country:US
Practice Address - Phone:561-767-6955
Practice Address - Fax:561-235-5649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder