Healthcare Provider Details

I. General information

NPI: 1063048346
Provider Name (Legal Business Name): BEHAVIORAL MOMENTUM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 US HIGHWAY 9
FREEHOLD NJ
07728-3554
US

IV. Provider business mailing address

2360 LAKEWOOD RD. STE 3, #102
TOMS RIVER NJ
08755
US

V. Phone/Fax

Practice location:
  • Phone: 732-994-7899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BILL TEICHMAN
Title or Position: ADMIN
Credential:
Phone: 732-363-1855