Provider Demographics
NPI:1689797839
Name:EASTER SEALS NEW JERSEY
Entity Type:Organization
Organization Name:EASTER SEALS NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-257-6662
Mailing Address - Street 1:1 KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2010
Mailing Address - Country:US
Mailing Address - Phone:732-257-6662
Mailing Address - Fax:732-257-7373
Practice Address - Street 1:241 FORSGATE DRIVE
Practice Address - Street 2:
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831
Practice Address - Country:US
Practice Address - Phone:732-257-6662
Practice Address - Fax:732-257-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40003-T40-00-41320800000X
NJ40003-T40-02-40320800000X
NJ40003-T40-03-40320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness