=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679350672
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BHABIKA ROBLES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2023
-----------------------------------------------------
Last Update Date | 09/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 445 BROADHOLLOW RD STE 25
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747-3645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-280-1327
-----------------------------------------------------
Fax | 516-453-1339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9249 172ND ST
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11433-1218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-306-7116
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------