Provider Demographics
NPI:1558139147
Name:DISCOVERY ABA NH LLC
Entity Type:Organization
Organization Name:DISCOVERY ABA NH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-736-5689
Mailing Address - Street 1:600 BAYVIEW AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11096-1606
Mailing Address - Country:US
Mailing Address - Phone:718-736-5689
Mailing Address - Fax:516-703-6240
Practice Address - Street 1:11 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4846
Practice Address - Country:US
Practice Address - Phone:718-736-5689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health