Provider Demographics
NPI:1316567290
Name:BULJETA, JAMIE L (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:BULJETA
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRIDGE PLZ N STE 275
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7586
Mailing Address - Country:US
Mailing Address - Phone:201-849-4565
Mailing Address - Fax:
Practice Address - Street 1:1 BRIDGE PLZ N STE 275
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7586
Practice Address - Country:US
Practice Address - Phone:201-849-4565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-18-32990103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932648086OtherGROUP NPI NUMBER