Provider Demographics
NPI:1023795580
Name:AUTISM SPORTS ACADEMY
Entity type:Organization
Organization Name:AUTISM SPORTS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHER
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SGROI
Authorized Official - Suffix:IV
Authorized Official - Credentials:MA
Authorized Official - Phone:201-674-3363
Mailing Address - Street 1:36 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-5918
Mailing Address - Country:US
Mailing Address - Phone:551-280-3172
Mailing Address - Fax:
Practice Address - Street 1:435 HOLLYWOOD AVE STE 11
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2406
Practice Address - Country:US
Practice Address - Phone:551-280-3172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health