Provider Demographics
NPI:1639142938
Name:PLANNED PARENTHOOD OF METROPOLITAN NEW JERSEY
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF METROPOLITAN NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:973-622-3900
Mailing Address - Street 1:151 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-3026
Mailing Address - Country:US
Mailing Address - Phone:973-622-3900
Mailing Address - Fax:973-622-1698
Practice Address - Street 1:750 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1452
Practice Address - Country:US
Practice Address - Phone:973-839-2363
Practice Address - Fax:973-839-5924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22623261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0007951Medicaid