NPIMap

Organization Active NPI

Center for Family Support, New Jersey, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Lincoln Park, NJ
National Provider Identifier
1700310760
Registry record updated Apr 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
GH1005 Issued in NJ
Legal business name
CENTER FOR FAMILY SUPPORT, NEW JERSEY, INC.
Practice address
107 Terrace Pkwy
Lincoln Park, NJ 07035-1926
Phone
(973) 709-0166
Fax
(973) 709-0477
NPI assigned
Apr 17, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2017

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

Authorized official

Name
Michael Mazzocco
Title
Assistant Executive Director
Phone
(212) 629-7939

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X GH1005 NJ Primary

Addresses

Primary practice location

107 Terrace Pkwy
Lincoln Park, NJ 07035-1926

Mailing address

333 7TH Ave FL 9
New York, NY 10001-5827

Other identifiers 1

IdentifierTypeStateIssuer
0471224MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Center for Family Support New Jersey Inc51 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492387200000",
    "number": "1700310760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 7TH AVE FL 9",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100015827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 TERRACE PKWY",
            "city": "LINCOLN PARK",
            "state": "NJ",
            "postal_code": "070351926",
            "telephone_number": "973-709-0166",
            "fax_number": "973-709-0477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR FAMILY SUPPORT, NEW JERSEY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-17",
        "last_updated": "2017-04-17",
        "status": "A",
        "authorized_official_last_name": "MAZZOCCO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ASSISTANT EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "212-629-7939"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NJ",
            "license": "GH1005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0471224",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2017; 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.