Provider Demographics
NPI:1326168840
Name:DEPARTMENT OF HEALTH AND SENIOR SERVICES
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH AND SENIOR SERVICES
Other - Org Name:NEW JERSEY EARLY INTERVENTION SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HLTH SCIENCE SPECIALIST PART C COOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:609-777-7734
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08625-0364
Mailing Address - Country:US
Mailing Address - Phone:609-777-7734
Mailing Address - Fax:609-292-0296
Practice Address - Street 1:50 E STATE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608-1715
Practice Address - Country:US
Practice Address - Phone:609-777-7734
Practice Address - Fax:609-292-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0056286Medicaid