Provider Demographics
NPI:1922363951
Name:EASTER SEALS NEW JERSEY
Entity Type:Organization
Organization Name:EASTER SEALS NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-257-6662
Mailing Address - Street 1:25 KENNEDY BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1259
Mailing Address - Country:US
Mailing Address - Phone:732-257-6662
Mailing Address - Fax:732-257-7373
Practice Address - Street 1:25 KENNEDY BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1259
Practice Address - Country:US
Practice Address - Phone:732-257-6662
Practice Address - Fax:732-257-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness