Provider Demographics
NPI:1609321256
Name:BANCROFT, A NEW JERSEY NONPROFIT CORPORATION
Entity Type:Organization
Organization Name:BANCROFT, A NEW JERSEY NONPROFIT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:PERGOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-348-1175
Mailing Address - Street 1:3900 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1108
Mailing Address - Country:US
Mailing Address - Phone:800-774-5516
Mailing Address - Fax:856-429-4755
Practice Address - Street 1:1255 CALDWELL RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3220
Practice Address - Country:US
Practice Address - Phone:856-348-1175
Practice Address - Fax:856-375-8358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPRF101103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ500549OtherMEDICARE PTAN