Healthcare Provider Details

I. General information

NPI: 1528986643
Provider Name (Legal Business Name): JEREMY MICHAEL GUTHARTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 MOUNT HOPE AVE APT X25
DOVER NJ
07801-1854
US

IV. Provider business mailing address

289 MOUNT HOPE AVE APT X25
DOVER NJ
07801-1854
US

V. Phone/Fax

Practice location:
  • Phone: 201-956-3094
  • Fax:
Mailing address:
  • Phone: 201-956-3094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-68862
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: