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General NPI Number Information
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NPI Number | 1306711734
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Entity Type | Organization
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Legal Business Name | T.A.G. THE ACADEMIC GYM LLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 51 MUKTANADA MARG
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City | WALDEN
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State | NY
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Zip | 12586-2352
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Country | US
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Telephone | 917-861-5243
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Fax | 845-787-0198
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Provider Business Mailing Address
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Address Line | 51 CONTINENTAL DR
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City | NEW WINDSOR
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State | NY
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Zip | 12553-5609
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Country | US
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Telephone | 917-861-5243
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Fax | 917-861-5243
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN CYRIL VIEIRA
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Credential |
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Telephone | 833-433-7323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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