Provider Demographics
NPI:1134481385
Name:BURST OF GENIUS INC
Entity Type:Organization
Organization Name:BURST OF GENIUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RODERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:917-495-7340
Mailing Address - Street 1:80 CHAUNCEY ST
Mailing Address - Street 2:APT. 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1809
Mailing Address - Country:US
Mailing Address - Phone:917-495-7340
Mailing Address - Fax:
Practice Address - Street 1:80 CHAUNCEY ST
Practice Address - Street 2:APT. 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1809
Practice Address - Country:US
Practice Address - Phone:917-495-7340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty