MEDICARE: SIMA KANAREK

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		NJ

General Provider Information

NPI Number	:	1366269912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMA KANAREK

Provider Business Mailing Address
First Line	:	20 AROSA HL
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2134
Country	:	US
Telephone Number	:	848-240-7743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 PROSPECT ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4611
Country	:	US
Telephone Number	:	732-367-0099
Fax Number	:

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

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	09/24/2024

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Directions to “ SIMA KANAREK ” Practice Location

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