Provider Demographics
NPI:1669852315
Name:EASTER SEALS NEW JERSEY
Entity Type:Organization
Organization Name:EASTER SEALS NEW JERSEY
Other - Org Name:ESNJ - PINE HILL SA (S)
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-257-6662
Mailing Address - Street 1:25 KENNEDY BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1259
Mailing Address - Country:US
Mailing Address - Phone:732-257-6662
Mailing Address - Fax:732-257-7373
Practice Address - Street 1:828 BLACKWOOD CLEMENTON ROAD
Practice Address - Street 2:CHATEAU RIDGE APTS, #I 174 & 177
Practice Address - City:PINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:08021
Practice Address - Country:US
Practice Address - Phone:856-627-2808
Practice Address - Fax:856-309-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health