Provider Demographics
NPI:1790029619
Name:THE SAMARITAN CENTER AT THE JERSEY SHORE
Entity Type:Organization
Organization Name:THE SAMARITAN CENTER AT THE JERSEY SHORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEIB
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:732-223-4673
Mailing Address - Street 1:36 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3440
Mailing Address - Country:US
Mailing Address - Phone:732-223-4673
Mailing Address - Fax:732-722-7867
Practice Address - Street 1:36 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3440
Practice Address - Country:US
Practice Address - Phone:732-223-4673
Practice Address - Fax:732-722-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00068100101Y00000X
NJ37AC00120300101Y00000X
NJ37LC00103300101YA0400X
NJ37PC00443500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty