1588354526 NPI number — UNLOCKING POTENTIAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588354526 NPI number — UNLOCKING POTENTIAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNLOCKING POTENTIAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588354526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 HANSOM LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLBORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07746-1755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-947-9762
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 HANSOM LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07746-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-947-9762
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RYBNICKY
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
PAIGE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-947-9762

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XE0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XE1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XF0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XG0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XL0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XN1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0019X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)