Provider Demographics
NPI:1871782334
Name:CATHOLIC CHARITIES DIOCESE OF METUCHEN
Entity type:Organization
Organization Name:CATHOLIC CHARITIES DIOCESE OF METUCHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:COTO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-324-8200
Mailing Address - Street 1:319 MAPLE ST
Mailing Address - Street 2:ATTN AVAZQUEZ
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4101
Mailing Address - Country:US
Mailing Address - Phone:732-324-8200
Mailing Address - Fax:
Practice Address - Street 1:24 ABEEL ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1303
Practice Address - Country:US
Practice Address - Phone:732-745-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES DIOCESE OF METUCHEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-22
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001980Medicare PIN
NJ861816Medicare PIN