MEDICARE: TABATHA GRACE PIZANIE MA, 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	11829645	NJ

General Provider Information

NPI Number	:	1861976201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABATHA GRACE PIZANIE MA, BCBA

Provider Business Mailing Address
First Line	:	8 CALIFORNIA AVE
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-2236
Country	:	US
Telephone Number	:	732-778-0815
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 CALIFORNIA AVE
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-2236
Country	:	US
Telephone Number	:	732-778-0815
Fax Number	:

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

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	09/21/2018

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