Provider Demographics
NPI:1306711734
Name:T.A.G. THE ACADEMIC GYM LLC
Entity type:Organization
Organization Name:T.A.G. THE ACADEMIC GYM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CYRIL
Authorized Official - Last Name:VIEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-433-7323
Mailing Address - Street 1:51 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5609
Mailing Address - Country:US
Mailing Address - Phone:917-861-5243
Mailing Address - Fax:917-861-5243
Practice Address - Street 1:51 MUKTANADA MARG
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-2352
Practice Address - Country:US
Practice Address - Phone:917-861-5243
Practice Address - Fax:845-787-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty