Provider Demographics
NPI:1609136712
Name:MOJKA, FONDA JAN (BCBA)
Entity Type:Individual
Prefix:
First Name:FONDA
Middle Name:JAN
Last Name:MOJKA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 PENNS WAY
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3068
Mailing Address - Country:US
Mailing Address - Phone:973-951-2068
Mailing Address - Fax:
Practice Address - Street 1:430 PENNS WAY
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3068
Practice Address - Country:US
Practice Address - Phone:973-951-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11210167103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst