Healthcare Provider Details

I. General information

NPI: 1528881158
Provider Name (Legal Business Name): YES ABA AZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N CENTRAL AVE STE 1800
PHOENIX AZ
85004-2139
US

IV. Provider business mailing address

PO BOX 995
LAKEWOOD NJ
08701-0995
US

V. Phone/Fax

Practice location:
  • Phone: 347-699-2092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MORDECHAI SZANZER
Title or Position: DIRECTOR
Credential:
Phone: 347-699-2092