1316586332 NPI number — MRS. ETTIL KAMENETZKY MS ED BCBA

Table of content: MRS. ETTIL KAMENETZKY MS ED BCBA (NPI 1316586332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316586332 NPI number — MRS. ETTIL KAMENETZKY MS ED BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAMENETZKY
Provider First Name:
ETTIL
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS ED BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEISS
Provider Other First Name:
ETTIL
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS ED BCBA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316586332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 COLORADO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08527-2107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-776-7834
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 COLORADO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08527-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-776-7834
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2019

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 , with the licence number:  1-19-3695 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com