Provider Demographics
NPI:1407164650
Name:IAC CENTER
Entity Type:Organization
Organization Name:IAC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANTELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:609-737-8750
Mailing Address - Street 1:2 TREE FARM RD
Mailing Address - Street 2:SUITE A200
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1435
Mailing Address - Country:US
Mailing Address - Phone:609-737-8750
Mailing Address - Fax:
Practice Address - Street 1:2 TREE FARM RD
Practice Address - Street 2:SUITE A200
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1435
Practice Address - Country:US
Practice Address - Phone:609-737-8750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJLCSW#44SC05190700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty