Healthcare Provider Details

I. General information

NPI: 1104598788
Provider Name (Legal Business Name): ABOVE AND BEYOND ABA NM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW STE 1200
ALBUQUERQUE NM
87102-5312
US

IV. Provider business mailing address

185 ROUTE 70 STE 302
TOMS RIVER NJ
08755-0936
US

V. Phone/Fax

Practice location:
  • Phone: 732-806-0091
  • Fax:
Mailing address:
  • Phone: 732-806-0091
  • Fax: 732-813-8001

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: MATT ROKOWKSY
Title or Position: MANAGER
Credential:
Phone: 402-252-1363