MEDICARE: AMY SZELIGA BCBA

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	001021-1	NY

General Provider Information

NPI Number	:	1255704227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SZELIGA BCBA

Provider Business Mailing Address
First Line	:	228 BEACH 98TH ST
Second Line	:	#3
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2849
Country	:	US
Telephone Number	:	718-926-9196
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 BEACH 98TH ST
Second Line	:	#3
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2849
Country	:	US
Telephone Number	:	718-926-9196
Fax Number	:

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

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	11/12/2015

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