Organization
JERSEY INNOVATIVE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIKA HOLLANDER (MANAGER)
(732) 614-6145
Entity
Organization
Contact information
Practice address
2360 LAKEWOOD RD, SUITE 3 #256, TOMS RIVER, NJ 08755-1929
(732) 614-6145
(732) 612-1162
Mailing address
2360 LAKEWOOD RD, SUITE 3 #256, TOMS RIVER, NJ 08755-1929
(732) 614-6145
(732) 612-1162
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
XXX
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0169994
—
NJ
Enumeration date
01/30/2017
Last updated
02/22/2017
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