Basic Information
| Provider Information | |||||||||
| NPI: | 1598283202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEREBRAL PALSY OF NORTH JERSEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 S ORANGE AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070395800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737639900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 685 691 14TH ST | ||||||||
| Address2: | |||||||||
| City: | PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0000000000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2017 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | BORNSTEIN | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9738218107 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | N | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 343800000X | N | Transportation Services | Secured Medical Transport (VAN) | 385H00000X | N | Respite Care Facility | Respite Care | 320600000X | Y | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 0479268 | 05 | NJ | MEDICAID |