# NJ SPROUT MC 1 LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tilly, Sprout Therapy, Elemy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588283709
- **Authorized official:** YURY YAKUBCHYK SR. (OWNER)
- **Authorized official phone:** (973) 755-9203

## Contact information

- **Practice address:** 101 EISENHOWER PKWY STE 300, ROSELAND, NJ 07068-1054
- **Practice address phone:** (833) 991-2368
- **Practice address fax:** (929) 384-7193
- **Mailing address:** 19 W 24TH ST FL 4, NEW YORK, NY 10010-3239
- **Mailing address phone:** (833) 458-0386
- **Mailing address fax:** (855) 461-3542

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | Yes |
| 103K00000X | Behavior Analyst | — | — | Yes |

## Other

- **Enumeration date:** 04/09/2020
- **Last updated:** 07/28/2025