Active NPI
City of East Orange
- Methadone Clinic
- East Orange, NJ
National Provider Identifier
1487888145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Methadone Clinic
- Legal business name
- CITY OF EAST ORANGE
- Doing business as
- East Orange Substance Abuse Treatment Program
- Practice address
- 110 South Grove Street, 3Rd Floor
East Orange, NJ 07018 - Phone
- (973) 266-5200
- Fax
- (973) 678-6843
- NPI assigned
- May 11, 2009
- Organization subpart
- Yes
- Parent organization
- CITY OF EAST ORANGE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Yvonne C. Blake
- Title
- Director
- Phone
- (973) 266-5200
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Clinical Social Worker | 1041C0700X | |||
| Nutrition Education Nutritionist | 133NN1002X | |||
| Psychiatry Physician | 2084P0800X | |||
| Methadone Clinic | 261QM2800X | Primary |
Addresses
Primary practice location
110 South Grove Street, 3Rd Floor
East Orange, NJ 07018
Mailing address
110 South Grove Street, 3Rd Floor
East Orange, NJ 07018
Phone (973) 266-5200
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0400476 | Medicaid | NJ | |
| 7667108 | Medicaid | NJ |
Other names 1
- East Orange Substance Abuse Treatment Program
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Opioid treatment program
- Medicare-enrolled since Jan 20, 2026
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191113003219 | NJ | Part B Supplier - Opioid Treatment Program (Otp) | 8921430976 | Practice locations: East Orange, NJ |
National Provider Directory
National Provider Directory- Part of
- East Orange HLTH Dept
Locations
110 S Grove St
Fl 3
East Orange, NJ 07018
Phone (862) 520-3937
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Lyndhurst, NJ
- NPI 1487666202
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242000000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1579132800000",
"number": "1487888145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 SOUTH GROVE STREET, 3RD FLOOR",
"city": "EAST ORANGE",
"state": "NJ",
"postal_code": "07018",
"telephone_number": "973-266-5200",
"fax_number": "973-678-6843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 SOUTH GROVE STREET, 3RD FLOOR",
"city": "EAST ORANGE",
"state": "NJ",
"postal_code": "07018",
"telephone_number": "973-266-5200",
"fax_number": "973-678-6843"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CITY OF EAST ORANGE",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CITY OF EAST ORANGE",
"enumeration_date": "2009-05-11",
"last_updated": "2020-01-16",
"certification_date": "2020-01-16",
"status": "A",
"authorized_official_last_name": "BLAKE",
"authorized_official_first_name": "YVONNE",
"authorized_official_middle_name": "C.",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "973-266-5200",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "133NN1002X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nutritionist, Nutrition, Education",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM2800X",
"taxonomy_group": "",
"desc": "Clinic/Center, Methadone",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0400476",
"state": "NJ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7667108",
"state": "NJ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "East Orange Substance Abuse Treatment Program",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in East Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.