Provider Demographics
NPI:1508392028
Name:JEWISH ASSOCIATION FOR DEVELOPMENTAL DISABILITIES
Entity Type:Organization
Organization Name:JEWISH ASSOCIATION FOR DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-457-0058
Mailing Address - Street 1:50 EISENHOWER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1438
Mailing Address - Country:US
Mailing Address - Phone:201-457-0058
Mailing Address - Fax:201-457-0025
Practice Address - Street 1:310 MANOR RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1536
Practice Address - Country:US
Practice Address - Phone:201-569-4235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH2096320900000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities