Healthcare Provider Details

I. General information

NPI: 1043120751
Provider Name (Legal Business Name): SAMUEL P MENKING RBT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 S 143RD PLZ
OMAHA NE
68144-5611
US

IV. Provider business mailing address

4403 15TH AVE STE 442
BROOKLYN NY
11219-1604
US

V. Phone/Fax

Practice location:
  • Phone: 402-266-6667
  • Fax:
Mailing address:
  • Phone: 718-500-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: