Active NPI
Marissa Gynn, BCBA
- Behavior Analyst
- Fort Lee, NJ
National Provider Identifier
1114243292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1084359
- Practice address
- 2400 Hudson Ter
2D
Fort Lee, NJ 07024-3520 - Phone
- (201) 264-3790
- NPI assigned
- Apr 14, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1084359 | NJ | Primary |
Addresses
Primary practice location
2400 Hudson Ter
2D
Fort Lee, NJ 07024-3520
Mailing address
2400 Hudson Ter
2D
Fort Lee, NJ 07024-3520
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1084359 | NJ | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271203200000",
"number": "1114243292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 HUDSON TER",
"address_2": "2D",
"city": "FORT LEE",
"state": "NJ",
"postal_code": "070243520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 HUDSON TER",
"address_2": "2D",
"city": "FORT LEE",
"state": "NJ",
"postal_code": "070243520",
"telephone_number": "201-264-3790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GYNN",
"first_name": "MARISSA",
"name_prefix": "Ms.",
"credential": "BCBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-14",
"last_updated": "2010-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NJ",
"license": "1084359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lee, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.