Provider Demographics
NPI:1306090238
Name:ADVANCED THERAPEUTIC CONCEPTS
Entity type:Organization
Organization Name:ADVANCED THERAPEUTIC CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-738-4362
Mailing Address - Street 1:100 LAWRENCE ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-5031
Mailing Address - Country:US
Mailing Address - Phone:845-738-4362
Mailing Address - Fax:
Practice Address - Street 1:100 LAWRENCE ST
Practice Address - Street 2:SUITE 109
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-5031
Practice Address - Country:US
Practice Address - Phone:845-738-4362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency