NPIMap

Organization Active NPI

North Jersey Community Research Initiative

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Newark, NJ
National Provider Identifier
1679063242
Registry record updated May 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
2000633 Issued in NJ
Legal business name
NORTH JERSEY COMMUNITY RESEARCH INITIATIVE
Practice address
393 Central Ave
Newark, NJ 07103-2842
Phone
(973) 483-3444
NPI assigned
May 18, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Corey Lyn Destefano
Title
Clinical Director
Phone
(973) 483-3444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 2000633 NJ Primary

Addresses

Primary practice location

393 Central Ave
Newark, NJ 07103-2842

Mailing address

393 Central Ave
Newark, NJ 07103-2842
Phone (973) 483-3444

Other identifiers 1

IdentifierTypeStateIssuer
0538027MedicaidNJ

Other names 1

  • NJCRI Doing business as

National Provider Directory

National Provider Directory
Tax ID family
N Jersey Comm Research Init3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526601600000",
    "number": "1679063242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 CENTRAL AVE",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032842",
            "telephone_number": "973-483-3444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 CENTRAL AVE",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032842",
            "telephone_number": "973-483-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH JERSEY COMMUNITY RESEARCH INITIATIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-18",
        "last_updated": "2018-05-18",
        "status": "A",
        "authorized_official_last_name": "DESTEFANO",
        "authorized_official_first_name": "COREY",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "973-483-3444"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NJ",
            "license": "2000633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0538027",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NJCRI",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NJCRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newark, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.