MEDICARE: ZLATY KAHAN MST BCBA

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	P13452	NY

General Provider Information

NPI Number	:	1881160646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZLATY KAHAN MST BCBA

Provider Business Mailing Address
First Line	:	4205 17TH AVE APT 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1029
Country	:	US
Telephone Number	:	347-675-6102
Fax Number	:

Provider Business Practice Location Address
First Line	:	4205 17TH AVE APT 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1029
Country	:	US
Telephone Number	:	347-675-6102
Fax Number	:

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

Provider Enumeration Date	:	10/19/2018
Last Update Date	:	10/19/2018

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