Provider Demographics
NPI:1487036125
Name:NATIONAL INSTITUTE FOR PEOPLE WITH DISABILITIES OF NEW JERSEY
Entity Type:Organization
Organization Name:NATIONAL INSTITUTE FOR PEOPLE WITH DISABILITIES OF NEW JERSEY
Other - Org Name:NIPD-NJ
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-358-5700
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-0301
Mailing Address - Country:US
Mailing Address - Phone:201-750-0509
Mailing Address - Fax:845-358-6119
Practice Address - Street 1:521 FARNHAM AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1206
Practice Address - Country:US
Practice Address - Phone:973-772-6484
Practice Address - Fax:973-772-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities