=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538080213
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE JAY ABA CO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2026
-----------------------------------------------------
Last Update Date | 07/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 SHERMAN STREET
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-813-2583
-----------------------------------------------------
Fax | 855-850-2583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 650 JAMES ST STE 101
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-4073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-813-2583
-----------------------------------------------------
Fax | 855-850-2583
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MORDY ROSENBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-813-2583
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------