Provider Demographics
NPI:1720419047
Name:MARBLEJAM KIDS INC.
Entity Type:Organization
Organization Name:MARBLEJAM KIDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ EXEC. DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:FILOMENA
Authorized Official - Last Name:VILLA-BAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-497-6512
Mailing Address - Street 1:214 STATE STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-497-6512
Mailing Address - Fax:201-942-4450
Practice Address - Street 1:214 STATE STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-497-6512
Practice Address - Fax:201-942-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0100982978OtherSTATE BUSINESS IDENTIFICATION NUMBER