=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346719044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCELLENCE LEARNING INSPIRING SUPPORTIVE ASSOCIATE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2018
-----------------------------------------------------
Last Update Date | 11/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 CARTER PL
-----------------------------------------------------
City | PARLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08859-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-268-0798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 CARTER PL
-----------------------------------------------------
City | PARLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08859-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-268-0798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ELISA GUIDICE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-268-0798
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------