Healthcare Provider Details

I. General information

NPI: 1922547645
Provider Name (Legal Business Name): BUTTERFLY BUDDIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 WOODSHORE W
KEYPORT NJ
07735-6122
US

IV. Provider business mailing address

3091 RTE 35
HAZLET NJ
07730-1519
US

V. Phone/Fax

Practice location:
  • Phone: 732-690-4811
  • Fax:
Mailing address:
  • Phone: 732-690-4811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JODY M WEISS
Title or Position: OWNER
Credential: HANDICAPPED TEACHER
Phone: 732-690-4811