# STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** North Jersey Developmental Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922046903
- **Authorized official:** MR. BRUCE WERKHEISER (CEO)
- **Authorized official phone:** (973) 890-4540

## Contact information

- **Practice address:** 169 MINNISINK RD, TOTOWA, NJ 07512-1803
- **Practice address phone:** (973) 256-1700
- **Practice address fax:** (973) 256-7651
- **Mailing address:** PO BOX 169, TOTOWA, NJ 07511-0169
- **Mailing address phone:** (973) 256-1700
- **Mailing address fax:** (973) 256-7651

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 06/03/2006
- **Last updated:** 03/27/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4497601 | — | NJ |
| 01 | — | 528584 | MEDICARE BILLING GROUP NO | NJ |