Provider Demographics
NPI:1144381039
Name:JEWISH FAMILY SERVICE OF METROWEST
Entity Type:Organization
Organization Name:JEWISH FAMILY SERVICE OF METROWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-765-9050
Mailing Address - Street 1:256 COLUMBIA TPKE STE 105
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1231
Mailing Address - Country:US
Mailing Address - Phone:973-765-9050
Mailing Address - Fax:973-765-0195
Practice Address - Street 1:256 COLUMBIA TPKE STE 105
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1231
Practice Address - Country:US
Practice Address - Phone:973-765-9050
Practice Address - Fax:973-765-0195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10150-01-04251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ655011Medicare UPIN
NJ655011Medicare ID - Type Unspecified