Healthcare Provider Details

I. General information

NPI: 1780931121
Provider Name (Legal Business Name): ACHIEVE BEYOND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 OCEANA DR W PH1D
BROOKLYN NY
11235-6662
US

IV. Provider business mailing address

60 OCEANA DR W PH1D
BROOKLYN NY
11235-6662
US

V. Phone/Fax

Practice location:
  • Phone: 646-529-2801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ERICA KHONONOV
Title or Position: ABA THERAPIST
Credential:
Phone: 646-529-2801