Provider Demographics
NPI:1861516015
Name:ACT PROGRAM
Entity type:Organization
Organization Name:ACT PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:MOSKOVITES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-645-7272
Mailing Address - Street 1:145 FINALE TERRACE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-2000
Mailing Address - Country:US
Mailing Address - Phone:301-593-8229
Mailing Address - Fax:
Practice Address - Street 1:145 FINALE TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-5059
Practice Address - Country:US
Practice Address - Phone:301-593-8229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM213429680242251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management