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NPI Code Detail

MEDICARE: BENJAMIN QUINLAN-BOMBYK BCBA, LBA

MEDICARE: BENJAMIN QUINLAN-BOMBYK BCBA, LBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1477897411
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN QUINLAN-BOMBYK BCBA, LBA
Provider Business Mailing Address
First Line : 2875 EYDE PKWY STE 100
Second Line :
City : EAST LANSING
State : MI
Zip : 48823-5431
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2875 EYDE PKWY STE 100
Second Line :
City : EAST LANSING
State : MI
Zip : 48823-5431
Country : US
Telephone Number : 517-624-2395
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2012
Last Update Date : 01/10/2025

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