MEDICARE: BLIMA CHAIFETZ 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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1649997032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLIMA CHAIFETZ BCBA

Provider Business Mailing Address
First Line	:	11 8TH ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2816
Country	:	US
Telephone Number	:	929-417-1070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 AVENUE OF THE STATES
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4789
Country	:	US
Telephone Number	:	732-961-7413
Fax Number	:

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

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	10/26/2022

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