Provider Demographics
NPI:1245798271
Name:CBP SQUARED LLC
Entity Type:Organization
Organization Name:CBP SQUARED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZZARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-250-6465
Mailing Address - Street 1:243 CONWAY ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1778
Mailing Address - Country:US
Mailing Address - Phone:848-250-6465
Mailing Address - Fax:
Practice Address - Street 1:243 CONWAY ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1778
Practice Address - Country:US
Practice Address - Phone:848-250-6465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management