MEDICARE: NEW JERSEY AUTISM CARE LLC

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	:	1871396978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW JERSEY AUTISM CARE LLC

Provider Business Mailing Address
First Line	:	5 PARAGON DR STE 105
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1739
Country	:	US
Telephone Number	:	845-327-7111
Fax Number	:	845-875-9420

Provider Business Practice Location Address
First Line	:	5 PARAGON DR STE 105
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1739
Country	:	US
Telephone Number	:	845-327-7111
Fax Number	:	845-875-9420

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	TALIA LOPEZ
Credential	:
Telephone Number	:	845-327-7111

Provider Enumeration Date	:	04/01/2025
Last Update Date	:	04/01/2025

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Directions to “NEW JERSEY AUTISM CARE LLC ” Practice Location

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