MEDICARE: REACH POTENTIAL LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	171400000X	Health & Wellness Coach
3	103T00000X	Psychologist
4	261QC1800X	Corporate Health Clinic/Center

General Provider Information

NPI Number	:	1528991866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REACH POTENTIAL LLC

Provider Business Mailing Address
First Line	:	418 BROADWAY STE 8587
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12207-2922
Country	:	US
Telephone Number	:	347-980-4112
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 HENRY PL
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1317
Country	:	US
Telephone Number	:	347-980-4112
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	DR. MARYHAN ABDELAZIM
Credential	:	PHD
Telephone Number	:	929-310-0057

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/12/2026

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Directions to “REACH POTENTIAL LLC ” Practice Location

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