Basic Information
| Provider Information | |||||||||
| NPI: | 1558740308 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | YELED V'YALDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1312 38TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112183612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186863700 | ||||||||
| FaxNumber: | 7186862395 | ||||||||
| Practice Location | |||||||||
| Address1: | 1312 38TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112183612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186863700 | ||||||||
| FaxNumber: | 7186862395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2015 | ||||||||
| LastUpdateDate: | 05/27/2015 | ||||||||
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| AuthorizedOfficialLastName: | IGEL | ||||||||
| AuthorizedOfficialFirstName: | SOLOMO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7186863500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | YELED V'YALDA | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.