Provider Demographics
NPI:1679789911
Name:CHILD FEDERATION OF A.C., INC.
Entity Type:Organization
Organization Name:CHILD FEDERATION OF A.C., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-272-1711
Mailing Address - Street 1:18 MARTIN LUTHER KING JR AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2406
Mailing Address - Country:US
Mailing Address - Phone:609-272-1711
Mailing Address - Fax:609-272-8970
Practice Address - Street 1:18 MARTIN LUTHER KING JR AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2406
Practice Address - Country:US
Practice Address - Phone:609-272-1711
Practice Address - Fax:609-272-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8614601Medicaid