Provider Demographics
NPI:1689295743
Name:FLORESTAL, BAIJNATHA (RBT)
Entity type:Individual
Prefix:MS
First Name:BAIJNATHA
Middle Name:
Last Name:FLORESTAL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-0516
Mailing Address - Country:US
Mailing Address - Phone:908-604-4500
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 516
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-0516
Practice Address - Country:US
Practice Address - Phone:908-604-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374J00000X
NJ19-104361106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No374J00000XNursing Service Related ProvidersDoula