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General NPI Number Information
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NPI Number | 1487044657
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Entity Type | Organization
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Legal Business Name | SN PEDIATRIC POTENTIALS, INC.
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 154 S LIVINGSTON AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3017
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Country | US
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Telephone | 973-535-5010
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Fax |
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Provider Business Mailing Address
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Address Line | 154 S LIVINGSTON AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3017
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. MARY ANN LORENG
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Credential | O.T.R./L
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Telephone | 973-535-5010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 46TR00072900
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License Number State | NJ
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