Healthcare Provider Details

I. General information

NPI: 1750990800
Provider Name (Legal Business Name): POSSIBILOT PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 JACKSON AVE APT 411
EDISON NJ
08837-3158
US

IV. Provider business mailing address

88 JACKSON AVE APT 411
EDISON NJ
08837-3158
US

V. Phone/Fax

Practice location:
  • Phone: 201-407-7923
  • Fax:
Mailing address:
  • Phone:
  • 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: MAUREEN D PASTOR POE
Title or Position: MS, OTR/L
Credential:
Phone: 862-305-0299