MEDICARE: ERIK M GULYAKO

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	551655111	NY

General Provider Information

NPI Number	:	1336401421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK M GULYAKO

Provider Business Mailing Address
First Line	:	3111 BRIGHTON 2ND ST
Second Line	:	APT 1E
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7535
Country	:	US
Telephone Number	:	347-372-3520
Fax Number	:

Provider Business Practice Location Address
First Line	:	2163 E 7TH ST
Second Line	:	#A
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4933
Country	:	US
Telephone Number	:	718-769-2698
Fax Number	:

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

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	06/13/2012

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