MEDICARE: NICOLE TURON-DIAZ

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	1-13-13518	NJ

General Provider Information

NPI Number	:	1245631720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE TURON-DIAZ

Provider Business Mailing Address
First Line	:	20 MOORE TER
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5014
Country	:	US
Telephone Number	:	973-650-7986
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 MOORE TER
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5014
Country	:	US
Telephone Number	:	973-650-7986
Fax Number	:

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

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	09/15/2014

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Directions to “ NICOLE TURON-DIAZ ” Practice Location

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