Provider Demographics
NPI:1477935146
Name:BANCROFT, A NEW JERSEY NONPROFIT CORPORATION
Entity type:Organization
Organization Name:BANCROFT, A NEW JERSEY NONPROFIT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-348-1196
Mailing Address - Street 1:1255 CALDWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08013
Mailing Address - Country:US
Mailing Address - Phone:856-348-4018
Mailing Address - Fax:856-216-1269
Practice Address - Street 1:1433 HOOPER AVE STE 131
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2238
Practice Address - Country:US
Practice Address - Phone:844-234-8387
Practice Address - Fax:856-429-4755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========Medicaid
NJ186396Medicare UPIN