Healthcare Provider Details

I. General information

NPI: 1992324982
Provider Name (Legal Business Name): PEAK BEHAVIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E OXFORD AVE
ALEXANDRIA VA
22301-1331
US

IV. Provider business mailing address

105 E OXFORD AVE
ALEXANDRIA VA
22301-1331
US

V. Phone/Fax

Practice location:
  • Phone: 732-492-4803
  • Fax:
Mailing address:
  • Phone: 732-492-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL NYMAN
Title or Position: OWNER
Credential:
Phone: 732-492-4803