Provider Demographics
NPI:1679052468
Name:CAREBRAL PALSY OF NORTH JERSEY
Entity type:Organization
Organization Name:CAREBRAL PALSY OF NORTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:973-821-8107
Mailing Address - Street 1:220 S ORANGE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5800
Mailing Address - Country:US
Mailing Address - Phone:973-763-9900
Mailing Address - Fax:
Practice Address - Street 1:1302 SUN VALLEY WAY
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-3038
Practice Address - Country:US
Practice Address - Phone:973-967-0335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0479268Medicaid