NPI 1003812728

Liberty Child and Adolescent Health Services

Organisation Specialist Jersey City, NJ

Practice location

Address: 550 Newark Ave, Jersey City, NJ 07306-1326
Phone: (201) 714-7902
Mailing address: PO Box 334, Wayne, NJ 07474-0334

Authorised official

Name: Richard J Bonforte
Title: President
Phone: (201) 714-7903

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X

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Registry record

NPI: 1003812728
Entity type: Organization
NPI issued: 27 Jun 2005
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.