MEDICARE: MACH ART ACADEMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1134009459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACH ART ACADEMY

Provider Business Mailing Address
First Line	:	6104 BERGENLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1560
Country	:	US
Telephone Number	:	201-428-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	6104 BERGENLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1560
Country	:	US
Telephone Number	:	201-428-2800
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANTOS MACH GONZALEZ
Credential	:
Telephone Number	:	201-899-0026

Provider Enumeration Date	:	09/05/2025
Last Update Date	:	09/05/2025

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