MEDICARE: MARY CORTESE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-21-55591	NJ

General Provider Information

NPI Number	:	1194410126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CORTESE

Provider Business Mailing Address
First Line	:	7 ALWOOD LN
Second Line	:
City	:	SUCCASUNNA
State	:	NJ
Zip	:	07876-1504
Country	:	US
Telephone Number	:	973-945-1232
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 BROADACRES DR
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-3153
Country	:	US
Telephone Number	:	201-371-6309
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	04/06/2023

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