Provider Demographics
NPI:1689436743
Name:GROSSMAN, MOISHE (BCBA, LBA)
Entity Type:Individual
Prefix:MR
First Name:MOISHE
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 42ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1213
Mailing Address - Country:US
Mailing Address - Phone:917-543-9707
Mailing Address - Fax:
Practice Address - Street 1:1301 45TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2102
Practice Address - Country:US
Practice Address - Phone:718-210-1722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003329103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst