Healthcare Provider Details

I. General information

NPI: 1801275870
Provider Name (Legal Business Name): BIG APPLE AUTISM SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2015
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 PUTNEY RD
VALLEY STREAM NY
11580-1818
US

IV. Provider business mailing address

1626 PUTNEY RD
VALLEY STREAM NY
11580-1818
US

V. Phone/Fax

Practice location:
  • Phone: 516-543-7710
  • Fax: 718-441-9373
Mailing address:
  • Phone: 516-543-7710
  • Fax: 718-441-9373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number000208
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number0117471
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number000208
License Number StateNY

VIII. Authorized Official

Name: MS. MARJORIE GABRIEL
Title or Position: PRESIDENT
Credential: MS.ED/BCBA
Phone: 516-543-7710