Provider Demographics
NPI:1750447207
Name:NORTH JERSEY FRIENDSHIP HOUSE, INC
Entity Type:Organization
Organization Name:NORTH JERSEY FRIENDSHIP HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DINORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AURIA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:201-488-2121
Mailing Address - Street 1:125 ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4135
Mailing Address - Country:US
Mailing Address - Phone:201-488-2121
Mailing Address - Fax:201-488-7161
Practice Address - Street 1:125 ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4135
Practice Address - Country:US
Practice Address - Phone:201-488-2121
Practice Address - Fax:201-488-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ920090105251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023507Medicaid
NJ0512583Medicaid