Healthcare Provider Details

I. General information

NPI: 1508440603
Provider Name (Legal Business Name): ENCORE FLOORTIME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 RUTGERS UNIVERSITY BLVD
LAKEWOOD NJ
08701-4537
US

IV. Provider business mailing address

1338 44TH ST
BROOKLYN NY
11219-2108
US

V. Phone/Fax

Practice location:
  • Phone: 347-743-7013
  • Fax:
Mailing address:
  • Phone: 347-743-7013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MORDECHAI T MEISELS
Title or Position: CCO
Credential:
Phone: 347-743-7013