Provider Demographics
NPI:1518664341
Name:JEWISH FAMILY & CHILDREN'S SERVICE OF GREATER MONMOUTH COUNTY
Entity Type:Organization
Organization Name:JEWISH FAMILY & CHILDREN'S SERVICE OF GREATER MONMOUTH COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KORNFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-774-6886
Mailing Address - Street 1:705 SUMMERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-6921
Mailing Address - Country:US
Mailing Address - Phone:732-774-6886
Mailing Address - Fax:
Practice Address - Street 1:25 KILMER DR STE 212
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1561
Practice Address - Country:US
Practice Address - Phone:732-774-6886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100980204OtherSTATE OF NEW JERSEY DEPARTMENT OF HEALTH
NJ0535826Medicaid