Healthcare Provider Details

I. General information

NPI: 1154129468
Provider Name (Legal Business Name): FLY WHEEL CENTER NE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4471 41ST AVE #1013
COLUMBUS NE
68601
US

IV. Provider business mailing address

174 WHITE ST
LAKEWOOD NJ
08701-4054
US

V. Phone/Fax

Practice location:
  • Phone: 347-661-6533
  • Fax:
Mailing address:
  • Phone: 347-524-8681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SHRAGA F WAXMAN
Title or Position: CEO
Credential:
Phone: 347-661-6533