MEDICARE: CHALLENGE ABA LICENSED BEHAVIOR ANALYST PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1093516544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHALLENGE ABA LICENSED BEHAVIOR ANALYST PLLC

Provider Business Mailing Address
First Line	:	1278 42ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-1324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1278 42ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-1324
Country	:	US
Telephone Number	:	347-743-7013
Fax Number	:

Authorized Official
Title or Position	:	CCO
Name	:	MORDECHAI MEISELS
Credential	:
Telephone Number	:	347-743-7013

Provider Enumeration Date	:	03/21/2025
Last Update Date	:	03/21/2025

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