MEDICARE: STRIDEABILITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700380011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRIDEABILITY LLC

Provider Business Mailing Address
First Line	:	21 HAMPTON PLACE
Second Line	:
City	:	NUTLEY
State	:	NJ
Zip	:	07110
Country	:	US
Telephone Number	:	917-294-6002
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 LIBERTY AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-4428
Country	:	US
Telephone Number	:	917-294-6002
Fax Number	:

Authorized Official
Title or Position	:	OWNER / DIRECTOR
Name	:	MRS. CARMELLE DOROTHY PHILLIPS
Credential	:	OTR/L
Telephone Number	:	917-294-6002

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	01/18/2024

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Directions to “STRIDEABILITY LLC ” Practice Location

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