Healthcare Provider Details

I. General information

NPI: 1184559205
Provider Name (Legal Business Name): JACOB SCOTT BEAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CLIFFWOOD AVE STE 100
MATAWAN NJ
07747-3930
US

IV. Provider business mailing address

14 CLIFFWOOD AVE STE 100
MATAWAN NJ
07747-3930
US

V. Phone/Fax

Practice location:
  • Phone: 732-466-3993
  • Fax:
Mailing address:
  • Phone: 732-466-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1510502
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: