Active NPI
Personalized Potential Center
- Developmental Disabilities Clinic/Center
- Elmwood Park, NJ
National Provider Identifier
1093229064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Disabilities Clinic/Center
- Legal business name
- PERSONALIZED POTENTIAL CENTER
- Practice address
- 20 Roosevelt Ave
Elmwood Park, NJ 07407-1031 - Phone
- (201) 956-0039
- NPI assigned
- Nov 28, 2017
- Last updated
- Nov 29, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Megan Pioch
- Title
- Chief Operating Officer
- Phone
- (201) 956-0039
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | NU | ||
| Adult Day Care Clinic/Center | 261QA0600X | NU | ||
| Developmental Disabilities Clinic/Center | 261QD1600X | NU | Primary | |
| Hearing and Speech Clinic/Center | 261QH0700X | NU | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | NU | ||
| Multi-Specialty Clinic/Center | 261QM1300X | NU | ||
| Physical Therapy Clinic/Center | 261QP2000X | NU | ||
| Rehabilitation Clinic/Center | 261QR0400X | NU | ||
| Occupational Medicine Clinic/Center | 261QX0100X | NU | ||
| Preferred Provider Organization | 305R00000X | NU | ||
| Point of Service | 305S00000X | NU | ||
| Private Vehicle | 347C00000X | NU | ||
| Respite Care | 385H00000X | NU | ||
| Non-Pharmacy Dispensing Site | 332900000X | NU | ||
| Community/Behavioral Health Agency | 251S00000X | NU |
Addresses
Primary practice location
20 Roosevelt Ave
Elmwood Park, NJ 07407-1031
Mailing address
20 Roosevelt Ave
Elmwood Park, NJ 07407-1031
Phone (201) 956-0039
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511827200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1511913600000",
"number": "1093229064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 ROOSEVELT AVE",
"city": "ELMWOOD PARK",
"state": "NJ",
"postal_code": "074071031",
"telephone_number": "201-956-0039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 ROOSEVELT AVE",
"city": "ELMWOOD PARK",
"state": "NJ",
"postal_code": "074071031",
"telephone_number": "201-956-0039"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PERSONALIZED POTENTIAL CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2017-11-28",
"last_updated": "2017-11-29",
"status": "A",
"authorized_official_last_name": "PIOCH",
"authorized_official_first_name": "MEGAN",
"authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
"authorized_official_telephone_number": "201-956-0039"
},
"taxonomies": [
{
"code": "251C00000X",
"taxonomy_group": "",
"desc": "Day Training, Developmentally Disabled Services",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QA0600X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adult Day Care",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QD1600X",
"taxonomy_group": "",
"desc": "Clinic/Center, Developmental Disabilities",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "261QH0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, Hearing and Speech",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QR0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QX0100X",
"taxonomy_group": "",
"desc": "Clinic/Center, Occupational Medicine",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "305R00000X",
"taxonomy_group": "",
"desc": "Preferred Provider Organization",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "305S00000X",
"taxonomy_group": "",
"desc": "Point of Service",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "385H00000X",
"taxonomy_group": "",
"desc": "Respite Care",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "332900000X",
"taxonomy_group": "",
"desc": "Non-Pharmacy Dispensing Site",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmwood Park, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.