MEDICARE: HIDDEN GEMS ABA -NC- LLC

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
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1568226371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIDDEN GEMS ABA -NC- LLC

Provider Business Mailing Address
First Line	:	600 E CRESCENT AVE STE 109
Second Line	:
City	:	UPPER SADDLE RIVER
State	:	NJ
Zip	:	07458-1846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 E CRESCENT AVE STE 109
Second Line	:
City	:	UPPER SADDLE RIVER
State	:	NJ
Zip	:	07458-1846
Country	:	US
Telephone Number	:	201-500-9915
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. YAKOV MORGENSTERN
Credential	:
Telephone Number	:	845-521-8221

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	06/21/2024

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