Healthcare Provider Details

I. General information

NPI: 1780432831
Provider Name (Legal Business Name): CHILDRENS SPECIALIZED HOSPITAL ABA, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 W VETERANS HWY
JACKSON NJ
08527-3410
US

IV. Provider business mailing address

175 BELGROVE DR
KEARNY NJ
07032-1507
US

V. Phone/Fax

Practice location:
  • Phone: 201-979-1336
  • Fax: 908-940-0338
Mailing address:
  • Phone: 216-216-9500
  • 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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID SUSSMAN
Title or Position: PRESIDENT
Credential:
Phone: 216-216-9500