Provider Demographics
NPI:1093847287
Name:CENTER FOR GREAT EXPECTATIONS
Entity Type:Organization
Organization Name:CENTER FOR GREAT EXPECTATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEG
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-247-7003
Mailing Address - Street 1:19 DELLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1551
Mailing Address - Country:US
Mailing Address - Phone:732-247-7003
Mailing Address - Fax:732-247-7043
Practice Address - Street 1:19 DELLWOOD LN
Practice Address - Street 2:BLDG. A
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1551
Practice Address - Country:US
Practice Address - Phone:732-247-7014
Practice Address - Fax:732-247-7063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2310251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7839308Medicaid
NJ0404471Medicaid
NJ0458279Medicaid
NJ8794901Medicaid