NPIMap

Organization Active NPI

Brave Wings Therapy, PC

  • Multi-Specialty Clinic/Center
  • Fairfield, NJ
National Provider Identifier
1497304430
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
BRAVE WINGS THERAPY, PC
Practice address
155 Passaic Ave
Fairfield, NJ 07004-3561
Phone
(973) 747-0456
NPI assigned
Sep 11, 2019
Last updated
Apr 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

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

Authorized official

Name
Jennifer D. MooreNPI 1144528662
Title
Owner
Phone
(973) 747-0456

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X
Speech-Language Pathologist 235Z00000X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

155 Passaic Ave
Fairfield, NJ 07004-3561

Mailing address

155 Passaic Ave
Fairfield, NJ 07004-3561
Phone (973) 747-0456

National Provider Directory

National Provider Directory

Locations

155 Passaic Ave
Fairfield, NJ 07004
Phone (973) 747-0456

1211 Hamburg Tpke
Ste 224
Wayne, NJ 07470
Phone (201) 696-0998

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776902400000",
    "number": "1497304430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 PASSAIC AVE",
            "city": "FAIRFIELD",
            "state": "NJ",
            "postal_code": "070043561",
            "telephone_number": "973-747-0456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 PASSAIC AVE",
            "city": "FAIRFIELD",
            "state": "NJ",
            "postal_code": "070043561",
            "telephone_number": "973-747-0456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAVE WINGS THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-11",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-747-0456"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2026; 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.