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General NPI Number Information
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NPI Number | 1154129468
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Entity Type | Organization
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Legal Business Name | FLY WHEEL CENTER NE LLC
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 4471 41ST AVE #1013
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City | COLUMBUS
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State | NE
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Zip | 68601
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Country | US
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Telephone | 347-661-6533
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Fax |
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Provider Business Mailing Address
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Address Line | 174 WHITE ST
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4054
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Country | US
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Telephone | 347-524-8681
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHRAGA F WAXMAN
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Credential |
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Telephone | 347-661-6533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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