Individual
IAN JAMES NUTKIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
329 AYCRIGG AVE, PASSAIC, NJ 07055-3713
(973) 471-3046
Mailing address
43 FAIRFIELD AVE, WEST CALDWELL, NJ 07006-7603
(973) 919-4503
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-12-10205
BACB
NJ
Enumeration date
08/05/2020
Last updated
08/05/2020
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