Organization Active NPI

City of East Orange

  • Methadone Clinic
  • East Orange, NJ
National Provider Identifier
1487888145
Registry record updated Jan 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
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 ORANGEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 16, 2020

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)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Nutrition Education NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133NN1002X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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

IdentifierTypeStateIssuer
0400476MedicaidNJ
7667108MedicaidNJ

Other names 1

  • East Orange Substance Abuse Treatment Program Doing business as

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 IDStateProvider typePAC IDDetails
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.

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.

Verify at the official NPI Registry.