MEDICARE: MR. SAMUEL KOHL BCBA

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	BACB921419	NY

General Provider Information

NPI Number	:	1366382566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL KOHL BCBA

Provider Business Mailing Address
First Line	:	46 BUDLEMAN WAY
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-6104
Country	:	US
Telephone Number	:	347-455-0102
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 BUDLEMAN WAY
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-6104
Country	:	US
Telephone Number	:	347-455-0102
Fax Number	:

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

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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