Healthcare Provider Details

I. General information

NPI: 1417868555
Provider Name (Legal Business Name): ELISE KLEIN BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 BEAVER DAM RD
POMONA NY
10970-3204
US

IV. Provider business mailing address

14 BEAVER DAM RD
POMONA NY
10970-3204
US

V. Phone/Fax

Practice location:
  • Phone: 845-915-0060
  • Fax:
Mailing address:
  • Phone: 845-915-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-26-2849817
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: