Healthcare Provider Details

I. General information

NPI: 1770025579
Provider Name (Legal Business Name): JAIR YEPEZ TORRES BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22107 100TH AVE
QUEENS VILLAGE NY
11429-1631
US

IV. Provider business mailing address

148 GREENWICH ST APT 304
HEMPSTEAD NY
11550-5673
US

V. Phone/Fax

Practice location:
  • Phone: 516-451-5420
  • Fax:
Mailing address:
  • Phone: 516-451-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number001808-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: