Provider Demographics
NPI:1922388628
Name:BRAIN INJURY RESOURCE GROUP
Entity Type:Organization
Organization Name:BRAIN INJURY RESOURCE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LISSITZ
Authorized Official - Suffix:
Authorized Official - Credentials:BA, ACBIS
Authorized Official - Phone:862-324-3456
Mailing Address - Street 1:86 WALNUT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07832-2789
Mailing Address - Country:US
Mailing Address - Phone:908-362-5862
Mailing Address - Fax:
Practice Address - Street 1:86 WALNUT VALLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:NJ
Practice Address - Zip Code:07832-2789
Practice Address - Country:US
Practice Address - Phone:908-362-5862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care