Provider Demographics
NPI:1649344219
Name:BOROUGH OF FAIR LAWN
Entity type:Organization
Organization Name:BOROUGH OF FAIR LAWN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOROUGH MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:METZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-794-5330
Mailing Address - Street 1:8-01 FAIR LAWN AVE
Mailing Address - Street 2:ROOM 112
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1800
Mailing Address - Country:US
Mailing Address - Phone:201-794-5330
Mailing Address - Fax:201-475-2975
Practice Address - Street 1:8-01 FAIR LAWN AVE
Practice Address - Street 2:ROOM 112
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1800
Practice Address - Country:US
Practice Address - Phone:201-794-5330
Practice Address - Fax:201-475-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077012Medicare ID - Type Unspecified
NJ427747Medicare ID - Type Unspecified