=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447176631
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE FLAVOR LAB, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2026
-----------------------------------------------------
Last Update Date | 06/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 514 LIVINGSTON STREET
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-292-3733
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51 KENNEDY CIR
-----------------------------------------------------
City | CLOSTER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07624-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CASEY JOJIC
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-292-3733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------