Healthcare Provider Details

I. General information

NPI: 1578408688
Provider Name (Legal Business Name): CAROLINE AMZALLAG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 AUSTIN ST STE 200
FOREST HILLS NY
11375-4739
US

IV. Provider business mailing address

687 DRIGGS AVE APT 3D
BROOKLYN NY
11211-4004
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-7633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number004837
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: