Provider Demographics
NPI:1821423518
Name:SKILLASTIC LLC
Entity Type:Organization
Organization Name:SKILLASTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RIVKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANAREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-734-8171
Mailing Address - Street 1:11 MIDTOWN CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-7604
Mailing Address - Country:US
Mailing Address - Phone:845-548-2857
Mailing Address - Fax:
Practice Address - Street 1:500 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4616
Practice Address - Country:US
Practice Address - Phone:845-548-2857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty