=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750192282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRAGONFLY APPLIED BEHAVIOR ANALYSIS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2025
-----------------------------------------------------
Last Update Date | 01/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 HYNES CT
-----------------------------------------------------
City | FARMINGDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11735-2259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-701-8005
-----------------------------------------------------
Fax | 516-706-1762
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 HYNES CT
-----------------------------------------------------
City | FARMINGDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11735-2259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-701-8005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ZOE PAPAZOGLOU
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 619-701-8005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------