MEDICARE: APPLIED BEHAVIOR ANALYST JOURNEY 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	:	1437905833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLIED BEHAVIOR ANALYST JOURNEY PLLC

Provider Business Mailing Address
First Line	:	1232B STERLING PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-2988
Country	:	US
Telephone Number	:	718-663-4023
Fax Number	:

Provider Business Practice Location Address
First Line	:	1232B STERLING PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-2988
Country	:	US
Telephone Number	:	718-663-4023
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. SHMUELI MILECKI
Credential	:
Telephone Number	:	718-663-4023

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	05/10/2024

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