Healthcare Provider Details

I. General information

NPI: 1114517513
Provider Name (Legal Business Name): SKILLZ OF NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 E RAILWAY AVE FL 2
PATERSON NJ
07503-1217
US

IV. Provider business mailing address

161 E 9TH ST
CLIFTON NJ
07011-1773
US

V. Phone/Fax

Practice location:
  • Phone: 973-653-9974
  • Fax:
Mailing address:
  • Phone: 201-321-2855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: TAREK ALNATUR
Title or Position: PRESIDENT
Credential:
Phone: 201-321-2855