Provider Demographics
NPI:1699828202
Name:OFFICE OF PUBLIC HEALTH NURSING
Entity Type:Organization
Organization Name:OFFICE OF PUBLIC HEALTH NURSING
Other - Org Name:SPECIAL CHILD HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UNIT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKLARZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-948-5239
Mailing Address - Street 1:129 MORRIS TPKE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-4913
Mailing Address - Country:US
Mailing Address - Phone:973-948-5239
Mailing Address - Fax:973-948-2270
Practice Address - Street 1:129 MORRIS TPKE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-4913
Practice Address - Country:US
Practice Address - Phone:973-948-5239
Practice Address - Fax:973-948-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3689212Medicaid