Provider Demographics
NPI:1962947531
Name:IYAHO SOCIAL SERVICES OF NEW JERSEY, INC
Entity type:Organization
Organization Name:IYAHO SOCIAL SERVICES OF NEW JERSEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:EROMOSELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-601-0669
Mailing Address - Street 1:137 EVERGREEN PL
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2005
Mailing Address - Country:US
Mailing Address - Phone:917-601-0669
Mailing Address - Fax:516-280-5933
Practice Address - Street 1:137 EVERGREEN PL
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2005
Practice Address - Country:US
Practice Address - Phone:917-601-0669
Practice Address - Fax:516-280-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0101035873251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable