MEDICARE: DR. ELLE BEN KIRSTEN PHD, MSC, 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
1	103K00000X	Behavior Analyst	1106880	NY

General Provider Information

NPI Number	:	1831524677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLE BEN KIRSTEN PHD, MSC, BCBA, LBA

Provider Business Mailing Address
First Line	:	4615 CENTER BLVD APT 3907
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5779
Country	:	US
Telephone Number	:	646-647-0942
Fax Number	:

Provider Business Practice Location Address
First Line	:	4615 CENTER BLVD APT 3907
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5779
Country	:	US
Telephone Number	:	646-647-0942
Fax Number	:

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

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	12/17/2021

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