Organization
NORTH JERSEY COMMUNITY RESEARCH INITIATIVE
Active
Other names
NJCRI
Organization subpart
No
Provider details
NPI number
Authorized official
COREY LYN DESTEFANO (CLINICAL DIRECTOR)
(973) 483-3444
Entity
Organization
Contact information
Practice address
393 CENTRAL AVE, NEWARK, NJ 07103-2842
(973) 483-3444
Mailing address
393 CENTRAL AVE, NEWARK, NJ 07103-2842
(973) 483-3444
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
2000633
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0538027
—
NJ
Enumeration date
05/18/2018
Last updated
05/18/2018
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