Provider Demographics
NPI:1518583145
Name:AMATEUR ATHLETIC UNION OF THE UNITED STATES / SPECIAL DRAGONS
Entity Type:Organization
Organization Name:AMATEUR ATHLETIC UNION OF THE UNITED STATES / SPECIAL DRAGONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTORY
Authorized Official - Suffix:
Authorized Official - Credentials:MAT SPECIAL EDUCATI
Authorized Official - Phone:973-667-8525
Mailing Address - Street 1:77 TIONA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2235
Mailing Address - Country:US
Mailing Address - Phone:973-667-8525
Mailing Address - Fax:
Practice Address - Street 1:242 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2329
Practice Address - Country:US
Practice Address - Phone:973-667-8525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMATEUR ATHLETIC UNION OF THE UNITED STATES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child