Healthcare Provider Details

I. General information

NPI: 1215840343
Provider Name (Legal Business Name): VIRGINIA PRACTICE-LOCATION ADDRESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR # 8473
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

178 NY-59 SUITE 312
MONSEY NY
10952-7831
US

V. Phone/Fax

Practice location:
  • Phone: 919-502-0944
  • Fax:
Mailing address:
  • Phone: 845-450-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DOV SMILOWITZ
Title or Position: MEMBER
Credential:
Phone: 845-450-0640