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NPI Code Detail

MEDICARE: CARL JEFFERSON JOSEPH

MEDICARE: CARL JEFFERSON JOSEPH
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1487334678
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARL JEFFERSON JOSEPH
Provider Business Mailing Address
First Line : 232 BIDWELL AVE APT 45
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07305-3394
Country : US
Telephone Number : 786-794-3127
Fax Number :
Provider Business Practice Location Address
First Line : 1 DEGRAW AVE
Second Line :
City : TEANECK
State : NJ
Zip : 07666-4094
Country : US
Telephone Number : 973-910-9040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2023
Last Update Date : 07/21/2023

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Directions to “ CARL JEFFERSON JOSEPH ” Practice Location

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