MEDICARE: MIND ORIENTATION LICENSED BEHAVIOR ANALYST 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
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1841868940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND ORIENTATION LICENSED BEHAVIOR ANALYST PLLC

Provider Business Mailing Address
First Line	:	4205 17TH AVE APT 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1029
Country	:	US
Telephone Number	:	347-675-6102
Fax Number	:

Provider Business Practice Location Address
First Line	:	4205 17TH AVE APT 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1029
Country	:	US
Telephone Number	:	347-675-6102
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ZLATY KAHAN
Credential	:
Telephone Number	:	347-675-6102

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	06/18/2024

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