Provider Demographics
NPI:1427756477
Name:SHALOM ABA SUPPORT LICENSED BEHAVIOR ANALYST PC
Entity type:Organization
Organization Name:SHALOM ABA SUPPORT LICENSED BEHAVIOR ANALYST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-676-7251
Mailing Address - Street 1:6 ROSE GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-7623
Mailing Address - Country:US
Mailing Address - Phone:917-676-7251
Mailing Address - Fax:
Practice Address - Street 1:681 CHESTNUT RIDGE AVE
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1095
Practice Address - Country:US
Practice Address - Phone:845-400-9870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty