MEDICARE: ENGAGING GROWTH ABA THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1326971250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENGAGING GROWTH ABA THERAPY PLLC

Provider Business Mailing Address
First Line	:	8200 SHORE FRONT PKWY APT 8B
Second Line	:
City	:	ROCKAWAY BEACH
State	:	NY
Zip	:	11693-2143
Country	:	US
Telephone Number	:	917-599-1125
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 SHORE FRONT PKWY APT 8B
Second Line	:
City	:	ROCKAWAY BEACH
State	:	NY
Zip	:	11693-2143
Country	:	US
Telephone Number	:	917-599-1125
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MRS. OLENA FAYERMAN
Credential	:	BCBA, LBA
Telephone Number	:	917-599-1125

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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