Organization
TIDAL ABA NJ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK BRAVMANN (CONTROLLER)
(718) 675-6957
Entity
Organization
Contact information
Practice address
820 BEAR TAVERN RD, EWING, NJ 08628-1021
(718) 736-5689
Mailing address
600 BAYVIEW AVE STE 400, INWOOD, NY 11096-1606
(718) 675-6957
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/13/2024
Last updated
02/13/2024
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