=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275272163
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEMIMOS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2022
-----------------------------------------------------
Last Update Date | 05/31/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 144 ADELAIDE PL
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-533-0212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 144 ADELAIDE PL
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-533-0212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ADINA JUDOWITZ
-----------------------------------------------------
Credential | OT
-----------------------------------------------------
Telephone | 917-533-0212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------