Provider Demographics
NPI:1275210601
Name:CHOICE ABA AUTISM SERVICES AZ
Entity Type:Organization
Organization Name:CHOICE ABA AUTISM SERVICES AZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MALKY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-893-1437
Mailing Address - Street 1:100 MATAWAN RD STE 325
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3911
Mailing Address - Country:US
Mailing Address - Phone:732-385-3300
Mailing Address - Fax:
Practice Address - Street 1:2 N CENTRAL AVE STE 1800
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2139
Practice Address - Country:US
Practice Address - Phone:732-385-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty