Healthcare Provider Details

I. General information

NPI: 1780340810
Provider Name (Legal Business Name): MIRIELA NEREY AMENEIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UNIVERSITY PLAZA DRIVE STE 100
HACKENSACK NJ
07601-6210
US

IV. Provider business mailing address

66 HAZELTON ST
RIDGEFIELD PARK NJ
07660-1142
US

V. Phone/Fax

Practice location:
  • Phone: 786-454-6443
  • Fax:
Mailing address:
  • Phone: 786-454-6443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-54382
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1-21-54382
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerBACB

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: