Provider Demographics
NPI:1891492179
Name:ABA MAND INC.
Entity Type:Organization
Organization Name:ABA MAND INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KSENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUSHERINA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:917-549-9999
Mailing Address - Street 1:10 SHORE BLVD APT 5K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4026
Mailing Address - Country:US
Mailing Address - Phone:917-549-9999
Mailing Address - Fax:
Practice Address - Street 1:10 SHORE BLVD APT 5K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4026
Practice Address - Country:US
Practice Address - Phone:917-549-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency