Provider Demographics
NPI:1528609344
Name:BRIGHT STAR SAPPHIRE THERAPY
Entity type:Organization
Organization Name:BRIGHT STAR SAPPHIRE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-803-1948
Mailing Address - Street 1:25-15 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3813
Mailing Address - Country:US
Mailing Address - Phone:732-803-1948
Mailing Address - Fax:883-227-0462
Practice Address - Street 1:25-15 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3813
Practice Address - Country:US
Practice Address - Phone:732-803-1948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty