Healthcare Provider Details

I. General information

NPI: 1346145646
Provider Name (Legal Business Name): CRHISLY MICHELLE CAMACHO JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 BRIDGE ST
METUCHEN NJ
08840-2277
US

IV. Provider business mailing address

110 MADISON AVE APT 2
PERTH AMBOY NJ
08861-4899
US

V. Phone/Fax

Practice location:
  • Phone: 732-578-8702
  • Fax:
Mailing address:
  • Phone: 732-293-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: