Healthcare Provider Details

I. General information

NPI: 1295057024
Provider Name (Legal Business Name): HYBRIDGE LEARNING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2010
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SCHANCK RD STE A-8
FREEHOLD NJ
07728-2963
US

IV. Provider business mailing address

55 SCHANCK RD STE A-8
FREEHOLD NJ
07728-2963
US

V. Phone/Fax

Practice location:
  • Phone: 732-702-2018
  • Fax:
Mailing address:
  • Phone: 732-702-2018
  • Fax: 908-271-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMIL MALIK BROWN
Title or Position: DIRECTOR
Credential: M.S.
Phone: 908-917-2552