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General NPI Number Information
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NPI Number | 1710315791
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Entity Type | Individual
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Provider Name | BRIAN CONNERS ED.S., BCBA
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Gender | Male
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 12/29/2017
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Provider Practice Location Address
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Address Line | 101 EISENHOWER PARKWAY SUITE 300
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City | ROSELAND
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State | NJ
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Zip | 07068-1054
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Country | US
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Telephone | 844-823-7865
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Fax | 844-711-9920
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Provider Business Mailing Address
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Address Line | 122 LINN DR APT A
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City | VERONA
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State | NJ
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Zip | 07044-3106
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Country | US
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Telephone | 973-896-9121
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Fax | 844-711-9920
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-13-13631
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License Number State | NJ
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