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General NPI Number Information
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NPI Number | 1609247402
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Entity Type | Organization
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Legal Business Name | ACHIEVE BEYOND
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 581 MAIN ST STE 640
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-1196
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Country | US
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Telephone | 718-762-7633
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Fax |
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Provider Business Mailing Address
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Address Line | 89 BERNICE RD
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1562
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Country | US
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Telephone | 973-508-6117
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Fax |
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Authorized Official
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Title or Position | NJ REGIONAL DIRECTOR
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Name | MS. MELINDA TEAGUE
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Credential |
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Telephone | 646-554-7205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number |
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License Number State | IL
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