Healthcare Provider Details

I. General information

NPI: 1962212118
Provider Name (Legal Business Name): FLY HIGH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MILTON ST
LAKEWOOD NJ
08701-1593
US

IV. Provider business mailing address

95 MILTON ST
LAKEWOOD NJ
08701-1593
US

V. Phone/Fax

Practice location:
  • Phone: 732-995-5708
  • Fax:
Mailing address:
  • Phone: 732-995-5708
  • 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: MISS RIVKA FLAM
Title or Position: CEO
Credential: BCBA
Phone: 732-995-5708