Provider Demographics
NPI:1174279194
Name:MATURE AUDIENCE, INC..
Entity Type:Organization
Organization Name:MATURE AUDIENCE, INC..
Other - Org Name:IGNIUS GLOBAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO OWNER CREATOR FOUNDER PCDOO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PAOLERCIO
Authorized Official - Suffix:I
Authorized Official - Credentials:CPO
Authorized Official - Phone:862-271-9417
Mailing Address - Street 1:21 NORTH ALBANY AVENUE UNIT 1
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401
Mailing Address - Country:US
Mailing Address - Phone:862-271-9417
Mailing Address - Fax:609-271-9447
Practice Address - Street 1:21 NORTH ALBANY AVE. UNIT 1
Practice Address - Street 2:FLOOR 1
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401
Practice Address - Country:US
Practice Address - Phone:862-271-9417
Practice Address - Fax:609-328-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251V00000XAgenciesVoluntary or Charitable