Provider Demographics
NPI:1760813661
Name:EASTER SEALS NEW JERSEY,INC
Entity Type:Organization
Organization Name:EASTER SEALS NEW JERSEY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:MARKS
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-257-6662
Mailing Address - Street 1:25 KENNEDY BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1262
Mailing Address - Country:US
Mailing Address - Phone:732-905-5324
Mailing Address - Fax:732-257-7373
Practice Address - Street 1:25 KENNEDY BLVD STE 600
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1262
Practice Address - Country:US
Practice Address - Phone:732-905-5324
Practice Address - Fax:732-257-7373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTER SEALS NEW JERSEY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00041500101YA0400X
NJ44SC049369001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty