Healthcare Provider Details

I. General information

NPI: 1114739224
Provider Name (Legal Business Name): AN INCREDIBLE ME ABA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6865 DEERPATH RD STE 101
ELKRIDGE MD
21075-6255
US

IV. Provider business mailing address

33 WOOD AVE S STE 600
ISELIN NJ
08830-2717
US

V. Phone/Fax

Practice location:
  • Phone: 410-220-0025
  • 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: MOSHE KRUPENIA
Title or Position: CEO
Credential:
Phone: 919-335-4463