Provider Demographics
NPI:1629436662
Name:BEHAVIOR ANALYSTS OF NJ, LLC
Entity Type:Organization
Organization Name:BEHAVIOR ANALYSTS OF NJ, LLC
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:
Practice Address - Street 1:25 ORCHARD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2173
Practice Address - Country:US
Practice Address - Phone:617-877-9757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-09-5526251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health