1295068872 NPI number — HEIGHTENED INDEPENDENCE AND PROGRESS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295068872 NPI number — HEIGHTENED INDEPENDENCE AND PROGRESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEIGHTENED INDEPENDENCE AND PROGRESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295068872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
HACKENSACK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07601-7140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-996-9100
Provider Business Mailing Address Fax Number:
201-996-9422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-7052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-996-9100
Provider Business Practice Location Address Fax Number:
201-996-9422
Provider Enumeration Date:
09/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GOFF
Authorized Official First Name:
EILEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
201-996-9100

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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