MEDICARE: AN INCREDIBLE ME ABA MD LLC

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1114739224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AN INCREDIBLE ME ABA MD LLC

Provider Business Mailing Address
First Line	:	33 WOOD AVE S STE 600
Second Line	:
City	:	ISELIN
State	:	NJ
Zip	:	08830-2717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6865 DEERPATH RD STE 101
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6255
Country	:	US
Telephone Number	:	410-220-0025
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MOSHE KRUPENIA
Credential	:
Telephone Number	:	919-335-4463

Provider Enumeration Date	:	01/24/2025
Last Update Date	:	01/24/2025

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