Provider Demographics
NPI:1699200741
Name:NEW JERSEY INSTITUTE FOR DISABILITIES, INC
Entity Type:Organization
Organization Name:NEW JERSEY INSTITUTE FOR DISABILITIES, INC
Other - Org Name:CEREBRAL PALSY ASSOCIATION OF MIDDLESEX COUNTY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-549-6187
Mailing Address - Street 1:10A OAK DR
Mailing Address - Street 2:ROOSEVELT PARK
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2313
Mailing Address - Country:US
Mailing Address - Phone:732-549-6187
Mailing Address - Fax:732-590-2431
Practice Address - Street 1:785 NEW DOVER RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1926
Practice Address - Country:US
Practice Address - Phone:732-549-6187
Practice Address - Fax:732-590-2431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH067320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0463477Medicaid