Provider Demographics
NPI:1578328548
Name:ES LICENSED BEHAVIOR ANALYSIS PLLC
Entity Type:Organization
Organization Name:ES LICENSED BEHAVIOR ANALYSIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIRON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMALOV
Authorized Official - Suffix:
Authorized Official - Credentials:LBA,BCBA, MSED
Authorized Official - Phone:347-476-4330
Mailing Address - Street 1:6527 ALDERTON ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5013
Mailing Address - Country:US
Mailing Address - Phone:347-476-4330
Mailing Address - Fax:
Practice Address - Street 1:6527 ALDERTON ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5013
Practice Address - Country:US
Practice Address - Phone:347-476-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty