Provider Demographics
NPI:1518033257
Name:PLANNED PARENTHOOD OF CENTRAL AND GREATER NORTHERN NJ
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF CENTRAL AND GREATER NORTHERN NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING AND REVENUE C
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-539-9580
Mailing Address - Street 1:196 SPEEDWELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-539-9580
Mailing Address - Fax:973-539-3828
Practice Address - Street 1:123 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060
Practice Address - Country:US
Practice Address - Phone:908-756-3736
Practice Address - Fax:908-756-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31D0111811261QA0005X
NJD06615806332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0045764Medicaid
PL535213Medicare ID - Type Unspecified