Provider Demographics
NPI:1528802097
Name:BRIDGE FOR INCLUSION
Entity type:Organization
Organization Name:BRIDGE FOR INCLUSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DIDOMENICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-865-6139
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-0112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2107
Practice Address - Country:US
Practice Address - Phone:973-865-6139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care