Provider Demographics
NPI:1881855542
Name:FAMILY SERVICE LEAGUE,INC.
Entity Type:Organization
Organization Name:FAMILY SERVICE LEAGUE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:973-746-0800
Mailing Address - Street 1:204 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3409
Mailing Address - Country:US
Mailing Address - Phone:973-746-0800
Mailing Address - Fax:973-746-2822
Practice Address - Street 1:204 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3409
Practice Address - Country:US
Practice Address - Phone:973-746-0800
Practice Address - Fax:973-746-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ657472Medicare PIN