Healthcare Provider Details

I. General information

NPI: 1669395281
Provider Name (Legal Business Name): OPENWING SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PORT IMPERIAL BLVD APT 126
WEEHAWKEN NJ
07086-7680
US

IV. Provider business mailing address

5 PORT IMPERIAL BLVD APT 126
WEEHAWKEN NJ
07086-7680
US

V. Phone/Fax

Practice location:
  • Phone: 646-669-3664
  • Fax: 646-669-3664
Mailing address:
  • Phone: 646-669-3664
  • Fax: 646-669-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: GEORGE ADOM
Title or Position: DIRECTOR
Credential:
Phone: 646-669-3664