Individual provider Active NPI

Kedar Idris Fluker

  • Behavior Analyst
  • East Orange, NJ
National Provider Identifier
1467266452
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
706650 Issued in NJ
Practice address
55 Glenwood Ave Apt 6L
East Orange, NJ 07017-1516
Phone
(860) 328-8397
NPI assigned
Feb 3, 2025
Last updated
Feb 3, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 706650 NJ Primary

Addresses

Primary practice location

55 Glenwood Ave Apt 6L
East Orange, NJ 07017-1516

Mailing address

55 Glenwood Ave Apt 6L
East Orange, NJ 07017-1516
Phone (860) 328-8397

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

LicenseStateTypeSpecialty
706650NJMDBehavioral Analyst

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1467266452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 GLENWOOD AVE APT 6L",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070171516",
            "telephone_number": "860-328-8397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 GLENWOOD AVE APT 6L",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070171516",
            "telephone_number": "860-328-8397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLUKER",
        "first_name": "KEDAR",
        "middle_name": "IDRIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-03",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NJ",
            "license": "706650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Orange, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.