Provider Demographics
NPI:1518689645
Name:HIDALGO, JOSHWIN ANTHONY (BCBA)
Entity Type:Individual
Prefix:
First Name:JOSHWIN
Middle Name:ANTHONY
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PARK DR APT 204
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-6004
Mailing Address - Country:US
Mailing Address - Phone:164-684-2659
Mailing Address - Fax:
Practice Address - Street 1:99 CORBETT WAY STE 102
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-4260
Practice Address - Country:US
Practice Address - Phone:732-655-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-22-60355103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst