NPIMap

Organization Active NPI

Mini Mine LLC

  • Clinic/Center
  • Lakewood, NJ
National Provider Identifier
1003557224
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MINI MINE LLC
Practice address
128 Melville Ave
Lakewood, NJ 08701-4235
Phone
(732) 886-8113
NPI assigned
Apr 3, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Malka Nussbaum, BCBANPI 1356681217
Title
Clinical Director
Phone
(732) 886-8113

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

128 Melville Ave
Lakewood, NJ 08701-4235

Mailing address

128 Melville Ave
Lakewood, NJ 08701-4235
Phone (732) 886-8113

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address orly@achievebt.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1003557224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 MELVILLE AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014235",
            "telephone_number": "732-886-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 MELVILLE AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014235",
            "telephone_number": "732-886-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINI MINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-03",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "NUSSBAUM",
        "authorized_official_first_name": "MALKA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "732-886-8113",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "orly@achievebt.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "126 Melville Ave",
            "city": "Lakewood",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "087014235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.