Provider Demographics
NPI:1265695977
Name:PROJECT99 LLC
Entity type:Organization
Organization Name:PROJECT99 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-565-9199
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-0388
Mailing Address - Country:US
Mailing Address - Phone:973-565-9199
Mailing Address - Fax:973-565-9599
Practice Address - Street 1:212 SHORT HILLS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1040
Practice Address - Country:US
Practice Address - Phone:973-565-9199
Practice Address - Fax:973-565-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023558Medicaid