MEDICARE: MR. SCOTT ERIC RIEGER NCC

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	:	1770861825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT ERIC RIEGER NCC

Provider Business Mailing Address
First Line	:	778 LAKEHURST AVE.
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527
Country	:	US
Telephone Number	:	732-928-9595
Fax Number	:

Provider Business Practice Location Address
First Line	:	778 LAKEHURST AVE
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-5244
Country	:	US
Telephone Number	:	732-928-9595
Fax Number	:

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

Provider Enumeration Date	:	07/22/2011
Last Update Date	:	07/22/2011

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