Provider Demographics
NPI:1407153455
Name:BEHAVIOR ANALYSTS OF NEW JERSEY
Entity Type:Organization
Organization Name:BEHAVIOR ANALYSTS OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJALEE
Authorized Official - Middle Name:SRIRAM
Authorized Official - Last Name:NIRGUDKAR
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:617-877-9757
Mailing Address - Street 1:50 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1327
Mailing Address - Country:US
Mailing Address - Phone:617-877-9757
Mailing Address - Fax:737-267-6703
Practice Address - Street 1:50 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1327
Practice Address - Country:US
Practice Address - Phone:617-877-9757
Practice Address - Fax:737-267-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1841503042OtherNATIONAL PROVIDER IDENTIFIER INDIVIDUAL