Healthcare Provider Details

I. General information

NPI: 1881520047
Provider Name (Legal Business Name): KEVIN P. VERBECK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 BARRYMORE BLVD
FRANKLIN SQUARE NY
11010-1607
US

IV. Provider business mailing address

58 BARRYMORE BLVD
FRANKLIN SQUARE NY
11010-1607
US

V. Phone/Fax

Practice location:
  • Phone: 516-857-2850
  • Fax:
Mailing address:
  • Phone: 516-857-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-82820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: