Provider Demographics
NPI:1821542481
Name:TOWNSHIP OF MIDDLETOWN
Entity Type:Organization
Organization Name:TOWNSHIP OF MIDDLETOWN
Other - Org Name:TOWNSHIP OF MIDDLETOWN- HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:DIBLASI
Authorized Official - Suffix:
Authorized Official - Credentials:MA CPS DRCC SAC
Authorized Official - Phone:732-615-2277
Mailing Address - Street 1:1 KINGS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748
Mailing Address - Country:US
Mailing Address - Phone:732-615-2277
Mailing Address - Fax:732-758-0566
Practice Address - Street 1:730 NEWMAN SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738
Practice Address - Country:US
Practice Address - Phone:732-615-2277
Practice Address - Fax:732-758-0566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWNSHIP OF MIDDLETOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health