Healthcare Provider Details

I. General information

NPI: 1215393467
Provider Name (Legal Business Name): FORWARD ABA GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 HIGHLAND AVE
RIDGEWOOD NJ
07450-4731
US

IV. Provider business mailing address

581 HIGHLAND AVE
RIDGEWOOD NJ
07450-4731
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-3676
  • Fax:
Mailing address:
  • Phone: 201-445-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RIMMA TARASOVSKY
Title or Position: CEO
Credential:
Phone: 201-445-3676