Provider Demographics
NPI:1891559555
Name:NJ DEVELOPMENTAL DISABILITY SERVICES
Entity Type:Organization
Organization Name:NJ DEVELOPMENTAL DISABILITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:718-419-9588
Mailing Address - Street 1:32 RUSTIC RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4017
Mailing Address - Country:US
Mailing Address - Phone:718-419-9588
Mailing Address - Fax:
Practice Address - Street 1:32 RUSTIC RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4017
Practice Address - Country:US
Practice Address - Phone:718-419-9588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities