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NPI Code Detail

MEDICARE: PROUD MOMENTS ABA SERVICES LLC

MEDICARE: PROUD MOMENTS ABA SERVICES LLC
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1962149260
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROUD MOMENTS ABA SERVICES LLC
Provider Business Mailing Address
First Line : 350 5TH AVE STE 6115
Second Line :
City : NEW YORK
State : NY
Zip : 10118-6002
Country : US
Telephone Number : 718-215-5311
Fax Number :
Provider Business Practice Location Address
First Line : 350 5TH AVE STE 6115
Second Line :
City : NEW YORK
State : NY
Zip : 10118-6002
Country : US
Telephone Number : 718-215-5311
Fax Number :
Authorized Official
Title or Position : GENERAL COUNSEL
Name : MR. MARK YOST JR.
Credential : ESQ
Telephone Number : 718-215-5311
Provider Enumeration Date : 05/18/2022
Last Update Date : 02/13/2025

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