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General NPI Number Information
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NPI Number | 1598257115
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Entity Type | Organization
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Legal Business Name | AMAZING STRIDES
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 625 BROAD ST STE 240
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City | NEWARK
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State | NJ
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Zip | 07102-4417
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Country | US
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Telephone | 973-241-3602
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Fax | 862-444-0135
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Provider Business Mailing Address
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Address Line | 225 RIDGEWOOD AVE UNIT 8152
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City | GLEN RIDGE
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State | NJ
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Zip | 07028-6619
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Country | US
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Telephone | 973-241-3602
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Fax | 862-444-0135
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Authorized Official
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Title or Position | FOUNDER/EXECUTIVE DIRECTOR
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Name | MRS. DOMINIQUE ANDERSON
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Credential |
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Telephone | 973-241-3602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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