Provider Demographics
NPI:1730892662
Name:FIVE BOROUGHS APPLIED BEHAVIOR ANALYSIS PC
Entity type:Organization
Organization Name:FIVE BOROUGHS APPLIED BEHAVIOR ANALYSIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MENASHE
Authorized Official - Middle Name:
Authorized Official - Last Name:EISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-551-4980
Mailing Address - Street 1:117 DITMAS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4901
Mailing Address - Country:US
Mailing Address - Phone:718-534-7400
Mailing Address - Fax:
Practice Address - Street 1:117 DITMAS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4901
Practice Address - Country:US
Practice Address - Phone:718-534-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty