Healthcare Provider Details

I. General information

NPI: 1194649871
Provider Name (Legal Business Name): CHRISTINA MEDORE MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 RIDGE RD
SUCCASUNNA NJ
07876-1841
US

IV. Provider business mailing address

27 RIDGE RD
SUCCASUNNA NJ
07876-1841
US

V. Phone/Fax

Practice location:
  • Phone: 973-407-9881
  • Fax:
Mailing address:
  • Phone: 973-407-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: