Provider Demographics
NPI:1104390632
Name:ZIEGLER, MENACHEM (BCBA)
Entity Type:Individual
Prefix:
First Name:MENACHEM
Middle Name:
Last Name:ZIEGLER
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 STETNER ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-2507
Mailing Address - Country:US
Mailing Address - Phone:917-838-1151
Mailing Address - Fax:
Practice Address - Street 1:9 STETNER ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-2507
Practice Address - Country:US
Practice Address - Phone:917-838-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-18-34379103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst