Provider Demographics
NPI:1801223227
Name:THE CENTER FOR SENSORY AND COMPLEX DISABILITIES
Entity Type:Organization
Organization Name:THE CENTER FOR SENSORY AND COMPLEX DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PETROFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:609-771-3083
Mailing Address - Street 1:2000 PENNINGTON ROAD
Mailing Address - Street 2:THE COLLEGE OF NEW JERSEY--CSCD
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628
Mailing Address - Country:US
Mailing Address - Phone:609-771-3083
Mailing Address - Fax:609-637-5144
Practice Address - Street 1:2000 PENNINGTON RD
Practice Address - Street 2:THE COLLEGE OF NEW JERSEY--CSCD
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628
Practice Address - Country:US
Practice Address - Phone:609-771-3083
Practice Address - Fax:609-637-5144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COLLEGE OF NEW JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services