Provider Demographics
NPI:1871396978
Name:NEW JERSEY AUTISM CARE LLC
Entity type:Organization
Organization Name:NEW JERSEY AUTISM CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-327-7111
Mailing Address - Street 1:5 PARAGON DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1739
Mailing Address - Country:US
Mailing Address - Phone:845-327-7111
Mailing Address - Fax:845-875-9420
Practice Address - Street 1:5 PARAGON DR STE 105
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1739
Practice Address - Country:US
Practice Address - Phone:845-327-7111
Practice Address - Fax:845-875-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty