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NPI Code Detail

MEDICARE: MR. MOISHE GROSSMAN BCBA, LBA

MEDICARE: MR. MOISHE GROSSMAN 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 Analyst003329NY

General Provider Information

NPI Number : 1689436743
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MOISHE GROSSMAN BCBA, LBA
Provider Business Mailing Address
First Line : 1156 42ND ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-1213
Country : US
Telephone Number : 917-543-9707
Fax Number :
Provider Business Practice Location Address
First Line : 1301 45TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-2102
Country : US
Telephone Number : 718-210-1722
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2024
Last Update Date : 01/24/2024

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