Provider Demographics
NPI:1154105914
Name:FETMAN, DAVID NISAN (BCBA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:NISAN
Last Name:FETMAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CURTIS PL
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-4214
Mailing Address - Country:US
Mailing Address - Phone:212-944-5828
Mailing Address - Fax:
Practice Address - Street 1:1326 E 10TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5754
Practice Address - Country:US
Practice Address - Phone:718-872-6051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty