Provider Demographics
NPI:1023455045
Name:STP UP-4 DEVELOPMENTAL DISABILITIES
Entity type:Organization
Organization Name:STP UP-4 DEVELOPMENTAL DISABILITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEONOR
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVIER
Authorized Official - Suffix:
Authorized Official - Credentials:BS-SOCIAL WORK
Authorized Official - Phone:201-647-0407
Mailing Address - Street 1:2339 HUDSON TER
Mailing Address - Street 2:SIUTTE B5-A
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7930
Mailing Address - Country:US
Mailing Address - Phone:201-647-0407
Mailing Address - Fax:
Practice Address - Street 1:9060 PALISADE AVE
Practice Address - Street 2:SUITE003
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6137
Practice Address - Country:US
Practice Address - Phone:201-647-0407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQUALIFIED PROVIDER347C00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle