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General NPI Number Information
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NPI Number | 1679105506
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Entity Type | Individual
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Provider Name | NEBROJAMOR DOUGLAS
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Gender | Male
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Dates
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Enumeration Date | 02/08/2020
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Last Update Date | 02/08/2020
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Provider Practice Location Address
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Address Line | 101 SHOREVIEW DR
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City | YONKERS
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State | NY
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Zip | 10710-1324
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Country | US
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Telephone | 914-318-5538
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Fax |
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Provider Business Mailing Address
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Address Line | 5 EDGEWATER CIR
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City | DANBURY
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State | CT
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Zip | 06810-6273
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Country | US
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Telephone | 917-856-4684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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