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General NPI Number Information
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NPI Number | 1205615952
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Entity Type | Organization
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Legal Business Name | EZRA BEHAVIORAL ANALYSIS, PC
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Dates
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Enumeration Date | 09/22/2023
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 181 STATION AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10309-2740
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Country | US
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Telephone | 348-808-3972
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Fax |
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Provider Business Mailing Address
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Address Line | 181 STATION AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10309-2740
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER LEVIN
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Credential |
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Telephone | 646-285-2558
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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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