1164710042 NPI number — MRS. JENNIFER ERIN IROFF M.S. BCBA

Table of content: GENA Y. WON M.D. (NPI 1588801013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164710042 NPI number — MRS. JENNIFER ERIN IROFF M.S. BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IROFF
Provider First Name:
JENNIFER
Provider Middle Name:
ERIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164710042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4492 ACWORTH INDUSTRIAL DR NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACWORTH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30101-5659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-232-9111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
335 PARKWAY 575
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30188-6433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-591-9552
Provider Business Practice Location Address Fax Number:
180-021-8824
Provider Enumeration Date:
07/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-11-8747 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1-11-8747 . This is a "BEHAVIOR ANALYSIS CERTIFICATION BOARD" identifier . This identifiers is of the category "OTHER".




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