Provider Demographics
NPI:1083037139
Name:BRIDGEWAY CIS
Entity type:Organization
Organization Name:BRIDGEWAY CIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-418-2379
Mailing Address - Street 1:373 CLERMONT TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8073
Mailing Address - Country:US
Mailing Address - Phone:908-418-2379
Mailing Address - Fax:908-248-9376
Practice Address - Street 1:506 3RD ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-1970
Practice Address - Country:US
Practice Address - Phone:908-355-7886
Practice Address - Fax:908-248-9376
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGEWAY REHABILITATION SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-27
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management