Provider Demographics
NPI:1508694167
Name:VICTORIA NJ ABA LLC
Entity type:Organization
Organization Name:VICTORIA NJ ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUNIGA
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:914-481-3262
Mailing Address - Street 1:701 STATE ROUTE 440 STE 16 JERSEY CITY, NEW JERSEY
Mailing Address - Street 2:#1094
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1069
Mailing Address - Country:US
Mailing Address - Phone:862-417-4746
Mailing Address - Fax:
Practice Address - Street 1:16 LYMAN AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-2714
Practice Address - Country:US
Practice Address - Phone:862-417-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty