Healthcare Provider Details

I. General information

NPI: 1457221657
Provider Name (Legal Business Name): BYRD'S OF PARADISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 POLIFLY RD
HACKENSACK NJ
07601-1029
US

IV. Provider business mailing address

295 POLIFLY RD
HACKENSACK NJ
07601-1029
US

V. Phone/Fax

Practice location:
  • Phone: 856-383-6253
  • Fax:
Mailing address:
  • Phone: 856-383-6253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
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: JAMAL STEPHON STEPHENS
Title or Position: CEO
Credential:
Phone: 856-383-6253