MEDICARE: GOLD STAR ABA

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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1851239321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD STAR ABA

Provider Business Mailing Address
First Line	:	80 BUCKINGHAM DR
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2640
Country	:	US
Telephone Number	:	347-277-7635
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 BUCKINGHAM DR
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2640
Country	:	US
Telephone Number	:	347-277-7635
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GITTY MANDEL
Credential	:	BCBA
Telephone Number	:	347-277-7635

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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