Provider Demographics
NPI:1356454615
Name:SERV CENTERS OF NEW JERSEY, INC
Entity Type:Organization
Organization Name:SERV CENTERS OF NEW JERSEY, INC
Other - Org Name:CLIFTON FAMILY OUTPATIENT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:609-406-0100
Mailing Address - Street 1:20 SCOTCH RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2503
Mailing Address - Country:US
Mailing Address - Phone:609-406-0100
Mailing Address - Fax:
Practice Address - Street 1:777 BLOOMFIELD AVE STE B
Practice Address - Street 2:SUITE B
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1242
Practice Address - Country:US
Practice Address - Phone:973-594-0125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ500049704261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00144001Medicaid
NJ00144001Medicaid