Healthcare Provider Details

I. General information

NPI: 1851166425
Provider Name (Legal Business Name): DPNJ AUTISM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2023
Last Update Date: 12/14/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 W PALISADE AVE STE 1064
ENGLEWOOD NJ
07631-2720
US

IV. Provider business mailing address

4 W PALISADE AVE STE 1064
ENGLEWOOD NJ
07631-2720
US

V. Phone/Fax

Practice location:
  • Phone: 201-503-6334
  • Fax:
Mailing address:
  • Phone: 201-503-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LUNA PAUL
Title or Position: MANAGING MEMBER
Credential:
Phone: 201-503-6334