1356065841 NPI number — BUILDING BLOCKS ACADEMY OF NEW JERSEY

Table of content: MRS. AIDA JANETH PETRLAK LMFT (NPI 1912068719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356065841 NPI number — BUILDING BLOCKS ACADEMY OF NEW JERSEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUILDING BLOCKS ACADEMY OF NEW JERSEY
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:
1356065841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOOD RIDGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07075-0024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-743-6975
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 VAN HOUTEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07013-2190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-743-6975
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2022

Additional Information

Authorized Official

Authorized Official Last Name:
OLAVARRIA
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
347-743-6975

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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