Provider Demographics
NPI:1942362041
Name:SERV CENTERS OF NEW JERSEY, INC
Entity Type:Organization
Organization Name:SERV CENTERS OF NEW JERSEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDDOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-406-0100
Mailing Address - Street 1:20 SCOTCH RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2529
Mailing Address - Country:US
Mailing Address - Phone:609-406-0100
Mailing Address - Fax:609-406-0307
Practice Address - Street 1:777 BLOOMFIELD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012
Practice Address - Country:US
Practice Address - Phone:973-594-0125
Practice Address - Fax:973-594-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8264503Medicaid