MEDICARE: JEFFREY MONTANO BCBA, LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1063256758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY MONTANO BCBA, LBA

Provider Business Mailing Address
First Line	:	363 ROOSEVELT ST
Second Line	:
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-1717
Country	:	US
Telephone Number	:	201-406-4435
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 WATER ST STE 1602
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10005-4432
Country	:	US
Telephone Number	:	212-235-5043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2024
Last Update Date	:	06/19/2024

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