Provider Demographics
NPI:1467773259
Name:BRIDGE INTO THE FUTURE
Entity Type:Organization
Organization Name:BRIDGE INTO THE FUTURE
Other - Org Name:NEW PATHWAY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MATTIACE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-436-1022
Mailing Address - Street 1:911 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4317
Mailing Address - Country:US
Mailing Address - Phone:201-360-3845
Mailing Address - Fax:201-360-3847
Practice Address - Street 1:911 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4317
Practice Address - Country:US
Practice Address - Phone:201-360-3845
Practice Address - Fax:201-360-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)