Provider Demographics
NPI:1336746403
Name:FOUR BOROUGHS ABA
Entity Type:Organization
Organization Name:FOUR BOROUGHS ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SIMCHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BENDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-668-9113
Mailing Address - Street 1:1344 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1344 E 24TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5143
Practice Address - Country:US
Practice Address - Phone:347-452-2665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty