MEDICARE: ACHIEVE MN LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1831989854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACHIEVE MN LLC

Provider Business Mailing Address
First Line	:	126 MELVILLE AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4235
Country	:	US
Telephone Number	:	732-886-8113
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 NORMANDALE LAKE BLVD STE 35
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-3813
Country	:	US
Telephone Number	:	732-886-8113
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MALKA NUSSBAUM
Credential	:
Telephone Number	:	732-886-8113

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	05/12/2025

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Directions to “ACHIEVE MN LLC ” Practice Location

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