Provider Demographics
NPI:1699937409
Name:THE CHALLENGE PROGRAM OF NJ
Entity type:Organization
Organization Name:THE CHALLENGE PROGRAM OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DORRITIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-345-9100
Mailing Address - Street 1:5 COLT ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1419
Mailing Address - Country:US
Mailing Address - Phone:973-345-9100
Mailing Address - Fax:973-345-9110
Practice Address - Street 1:5 COLT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1419
Practice Address - Country:US
Practice Address - Phone:973-345-9100
Practice Address - Fax:973-345-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22583261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8102503Medicaid