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General NPI Number Information
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NPI Number | 1730551292
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Entity Type | Individual
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Provider Name | CHRISTINE WIELADEK I
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Gender | Female
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 1 INTERNATIONAL BLVD STE 400
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City | MAHWAH
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State | NJ
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Zip | 07495-0025
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Country | US
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Telephone | 201-512-8746
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Fax | 201-512-8810
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Provider Business Mailing Address
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Address Line | 6 WISTERIA CT
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City | GLENWOOD
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State | NJ
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Zip | 07418-1940
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Country | US
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Telephone | 609-276-3620
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-11-9323
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License Number State | NJ
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