Healthcare Provider Details

I. General information

NPI: 1164336509
Provider Name (Legal Business Name): GIGI LIN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 RTE 46
ROCKAWAY NJ
07866-4039
US

IV. Provider business mailing address

110A WAVECREST AVE
WINFIELD PARK NJ
07036-7569
US

V. Phone/Fax

Practice location:
  • Phone: 973-876-1778
  • Fax: 973-584-6290
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2850442
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: