Healthcare Provider Details

I. General information

NPI: 1992651822
Provider Name (Legal Business Name): MR. JAMES JOSEPH SELLITTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 LAKESIDE DR N
FORKED RIVER NJ
08731-2405
US

IV. Provider business mailing address

435 LAKESIDE DR N
FORKED RIVER NJ
08731-2405
US

V. Phone/Fax

Practice location:
  • Phone: 609-500-1381
  • Fax:
Mailing address:
  • Phone: 609-500-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-514508
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: