Healthcare Provider Details

I. General information

NPI: 1528991866
Provider Name (Legal Business Name): REACH POTENTIAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HENRY PL
STATEN ISLAND NY
10305-1317
US

IV. Provider business mailing address

418 BROADWAY STE 8587
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 347-980-4112
  • Fax:
Mailing address:
  • Phone: 347-980-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARYHAN ABDELAZIM
Title or Position: FOUNDER
Credential: PHD
Phone: 929-310-0057