Healthcare Provider Details

I. General information

NPI: 1013873363
Provider Name (Legal Business Name): MRS. EMILIE FARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 ROUTE 206
FLANDERS NJ
07836-9189
US

IV. Provider business mailing address

34 TIMBERLINE RD
BUDD LAKE NJ
07828-2900
US

V. Phone/Fax

Practice location:
  • Phone: 201-562-9411
  • Fax:
Mailing address:
  • Phone: 973-222-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: