Provider Demographics
NPI:1760804108
Name:AUTISM GEARS LLC
Entity Type:Organization
Organization Name:AUTISM GEARS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTRYN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:720-346-1626
Mailing Address - Street 1:5 SOUTHSIDE DR
Mailing Address - Street 2:SUITE 11, #125
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3870
Mailing Address - Country:US
Mailing Address - Phone:720-346-1626
Mailing Address - Fax:
Practice Address - Street 1:5 SOUTHSIDE DR
Practice Address - Street 2:SUITE 11, #125
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3870
Practice Address - Country:US
Practice Address - Phone:720-346-1626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-18
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1107198103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty