Healthcare Provider Details

I. General information

NPI: 1679312151
Provider Name (Legal Business Name): HUNTER BERNARD BAILLIE RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 KINGSTON DR
LIVINGSTON NJ
07039
US

IV. Provider business mailing address

6 AUGUSTA DR
WEST HAMPTON NJ
08060
US

V. Phone/Fax

Practice location:
  • Phone: 732-858-2665
  • Fax:
Mailing address:
  • Phone: 609-686-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-257199
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: