Provider Demographics
NPI:1174255566
Name:BRIGHT SHINE LICENSED BEHAVIOR ANALYST PC
Entity Type:Organization
Organization Name:BRIGHT SHINE LICENSED BEHAVIOR ANALYST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZITRONENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:BACB293931
Authorized Official - Phone:917-573-9007
Mailing Address - Street 1:1458 50TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3678
Mailing Address - Country:US
Mailing Address - Phone:917-573-9007
Mailing Address - Fax:
Practice Address - Street 1:1458 50TH ST APT 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3678
Practice Address - Country:US
Practice Address - Phone:917-573-9007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1558626606OtherSPED