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NPI Code Detail

MEDICARE: NY'JA EDDIE

MEDICARE: NY'JA EDDIE
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 : 1689483406
Entity Type Code : Individual
Provider Name (Legal Business Name) : NY'JA EDDIE
Provider Business Mailing Address
First Line : 1449 HIGHLAND AVE
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-2027
Country : US
Telephone Number : 269-363-8584
Fax Number :
Provider Business Practice Location Address
First Line : 2400 NILES AVE
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-1922
Country : US
Telephone Number : 262-337-2292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2025
Last Update Date : 01/06/2025

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Directions to “ NY'JA EDDIE ” Practice Location

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