Provider Demographics
NPI:1578840211
Name:JERSEY ASSOCIATION FOR AUTISTIC CHILDREN- BRAINBUILDERS
Entity Type:Organization
Organization Name:JERSEY ASSOCIATION FOR AUTISTIC CHILDREN- BRAINBUILDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHEVY
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:732-534-5342
Mailing Address - Street 1:761 RIVER AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5200
Mailing Address - Country:US
Mailing Address - Phone:732-534-5342
Mailing Address - Fax:
Practice Address - Street 1:761 RIVER AVE STE D
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5200
Practice Address - Country:US
Practice Address - Phone:732-534-5342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherABA THERAPY