Provider Demographics
NPI:1750990800
Name:POSSIBILOT PEDIATRICS, LLC
Entity type:Organization
Organization Name:POSSIBILOT PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS, OTR/L
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PASTOR POE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-305-0299
Mailing Address - Street 1:88 JACKSON AVE APT 411
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:88 JACKSON AVE APT 411
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3158
Practice Address - Country:US
Practice Address - Phone:201-407-7923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty