Provider Demographics
NPI:1861677502
Name:TOWNSHIP OF MILLBURN
Entity Type:Organization
Organization Name:TOWNSHIP OF MILLBURN
Other - Org Name:MILLBURN HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GABLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:973-564-7079
Mailing Address - Street 1:375 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1377
Mailing Address - Country:US
Mailing Address - Phone:973-564-7087
Mailing Address - Fax:973-564-7086
Practice Address - Street 1:375 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1377
Practice Address - Country:US
Practice Address - Phone:973-564-7087
Practice Address - Fax:973-564-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251K00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ172663Medicare PIN