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General NPI Number Information
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NPI Number | 1710779111
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Entity Type | Organization
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Legal Business Name | FOREVERBLOOM ABA LLC
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 2 BROWER CT
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4097
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Country | US
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Telephone | 732-252-4827
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Fax |
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Provider Business Mailing Address
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Address Line | 2 BROWER CT
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4097
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Country | US
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Telephone | 732-252-4827
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NISHRIN GHADIALI
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Credential |
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Telephone | 732-252-4827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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