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NPI Code Detail

MEDICARE: YEHUDIS SIMON MSED, BCBA

MEDICARE: YEHUDIS SIMON MSED, BCBA
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
1103K00000XBehavior Analyst1-23-67270NJ

General Provider Information

NPI Number : 1407538275
Entity Type Code : Individual
Provider Name (Legal Business Name) : YEHUDIS SIMON MSED, BCBA
Provider Business Mailing Address
First Line : 80 HILLSIDE BLVD
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-3798
Country : US
Telephone Number : 732-890-2263
Fax Number :
Provider Business Practice Location Address
First Line : 80 HILLSIDE BLVD
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-3798
Country : US
Telephone Number : 732-534-7325
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2023
Last Update Date : 08/02/2023

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