Provider Demographics
NPI:1881958817
Name:BUDDIES OF NEW JERSEY, INC.
Entity type:Organization
Organization Name:BUDDIES OF NEW JERSEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:201-489-2900
Mailing Address - Street 1:149 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6823
Mailing Address - Country:US
Mailing Address - Phone:201-489-2900
Mailing Address - Fax:201-489-2133
Practice Address - Street 1:61 GRAND AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3572
Practice Address - Country:US
Practice Address - Phone:914-671-3924
Practice Address - Fax:845-942-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0250431Medicaid