Provider Demographics
NPI:1851167779
Name:MORDECHAI MEISELS LICENSED BEHAVIOR ANALYST PC
Entity type:Organization
Organization Name:MORDECHAI MEISELS LICENSED BEHAVIOR ANALYST PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:MR
Authorized Official - First Name:MORDECHAI
Authorized Official - Middle Name:TZVI
Authorized Official - Last Name:MEISELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-743-7013
Mailing Address - Street 1:1667-42 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4202 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1335
Practice Address - Country:US
Practice Address - Phone:347-743-7013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty