Provider Demographics
NPI:1124578950
Name:PLANNED PARENTHOOD OF CENTRAL AND GREATER NORTHERN NEW JERSEY, INC
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF CENTRAL AND GREATER NORTHERN NEW JERSEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRISTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-539-9580
Mailing Address - Street 1:196 SPEEDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-2934
Mailing Address - Country:US
Mailing Address - Phone:973-539-9580
Mailing Address - Fax:973-539-3828
Practice Address - Street 1:196 SPEEDWELL AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-2934
Practice Address - Country:US
Practice Address - Phone:973-539-9580
Practice Address - Fax:973-539-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QA0005X, 261QA1903X, 261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0045705Medicaid