Healthcare Provider Details

I. General information

NPI: 1356193577
Provider Name (Legal Business Name): FUNCTION FLIP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 ASHLAND AVE # 1
BLOOMFIELD NJ
07003-2418
US

IV. Provider business mailing address

197 ASHLAND AVE # 1
BLOOMFIELD NJ
07003-2418
US

V. Phone/Fax

Practice location:
  • Phone: 973-415-9405
  • Fax:
Mailing address:
  • Phone: 973-415-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ELLEN JAMES
Title or Position: CEO, OCCUPATIONAL THERAPIST
Credential: EDD, OTR/L
Phone: 973-415-9405