MEDICARE: LYRIC J BADA

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	:	1134965940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYRIC J BADA

Provider Business Mailing Address
First Line	:	30 DONGAN PL APT 4B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10040-1563
Country	:	US
Telephone Number	:	646-256-4618
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 DONGAN PL APT 4B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10040-1563
Country	:	US
Telephone Number	:	646-256-4618
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	07/02/2024

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