Provider Demographics
NPI:1033680970
Name:CHANCE TO ADVANCE, LLC
Entity Type:Organization
Organization Name:CHANCE TO ADVANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDYBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-791-9787
Mailing Address - Street 1:68 WATERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4246
Mailing Address - Country:US
Mailing Address - Phone:718-791-9787
Mailing Address - Fax:732-817-0770
Practice Address - Street 1:68 WATERFORD AVE
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-4246
Practice Address - Country:US
Practice Address - Phone:718-791-9787
Practice Address - Fax:732-817-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty