Healthcare Provider Details

I. General information

NPI: 1104390632
Provider Name (Legal Business Name): MENACHEM ZIEGLER LMSW, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 STETNER ST
SPRING VALLEY NY
10977-2507
US

IV. Provider business mailing address

9 STETNER ST
SPRING VALLEY NY
10977-2507
US

V. Phone/Fax

Practice location:
  • Phone: 917-838-1151
  • Fax:
Mailing address:
  • Phone: 917-838-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123640
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-34379
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: