Provider Demographics
NPI:1740655182
Name:LEISURE BRIDGES
Entity type:Organization
Organization Name:LEISURE BRIDGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-343-6000
Mailing Address - Street 1:540 FARVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-343-6000
Mailing Address - Fax:201-996-6974
Practice Address - Street 1:296 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4820
Practice Address - Country:US
Practice Address - Phone:201-343-6000
Practice Address - Fax:201-291-0492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERGEN COUNTY SPECIAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health