Healthcare Provider Details

I. General information

NPI: 1174448310
Provider Name (Legal Business Name): EMPIRE ABA VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E MAIN ST FL 16
NORFOLK VA
23510-2205
US

IV. Provider business mailing address

1515 PINE ST STE 207
LAKEWOOD NJ
08701-4993
US

V. Phone/Fax

Practice location:
  • Phone: 910-773-1234
  • Fax:
Mailing address:
  • Phone: 910-773-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YEHOSHUA SCHEINER
Title or Position: COO
Credential:
Phone: 910-773-1234