Provider Demographics
NPI:1669861100
Name:CEREBRAL PALSY OF NORTH JERSEY, INC.
Entity Type:Organization
Organization Name:CEREBRAL PALSY OF NORTH JERSEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-821-8107
Mailing Address - Street 1:220 S ORANGE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5804
Mailing Address - Country:US
Mailing Address - Phone:973-763-9900
Mailing Address - Fax:973-763-9905
Practice Address - Street 1:220 S ORANGE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5804
Practice Address - Country:US
Practice Address - Phone:973-763-9900
Practice Address - Fax:973-763-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH1828322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0427977Medicaid