Provider Demographics
NPI:1356968689
Name:PREPARING ADOLOSCENTS & ADULTS IDEOLOGIES NOW
Entity type:Organization
Organization Name:PREPARING ADOLOSCENTS & ADULTS IDEOLOGIES NOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-766-7786
Mailing Address - Street 1:207 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2002
Mailing Address - Country:US
Mailing Address - Phone:973-341-7567
Mailing Address - Fax:
Practice Address - Street 1:207 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2002
Practice Address - Country:US
Practice Address - Phone:973-341-7567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center