=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851166425
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DPNJ AUTISM SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2023
-----------------------------------------------------
Last Update Date | 12/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 W PALISADE AVE STE 1064
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-2720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-503-6334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 W PALISADE AVE STE 1064
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-2720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-503-6334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. LUNA PAUL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-503-6334
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0006X
-----------------------------------------------------
Taxonomy Name | Developmental - Behavioral Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------