Healthcare Provider Details

I. General information

NPI: 1346152188
Provider Name (Legal Business Name): JEREMY MIKHAEL DE TENORIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424A ELIZABETH ST
FORT LEE NJ
07024-2615
US

IV. Provider business mailing address

424A ELIZABETH ST
FORT LEE NJ
07024-2615
US

V. Phone/Fax

Practice location:
  • Phone: 201-509-0152
  • Fax:
Mailing address:
  • Phone: 201-509-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: