=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407767767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRAYON KARE NJ LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2026
-----------------------------------------------------
Last Update Date | 09/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 VAN VORST ST FL 2
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07302-4421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-366-9112
-----------------------------------------------------
Fax | 385-527-7501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 N COUNTY LINE RD STE 300
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08527-0150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-366-9112
-----------------------------------------------------
Fax | 385-527-7501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | STEVE GELLIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-366-9112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------