Provider Demographics
NPI:1801674601
Name:MALKA NUSSBAUM LICENSED BEHAVIORAL ANALYST, PLLC
Entity type:Organization
Organization Name:MALKA NUSSBAUM LICENSED BEHAVIORAL ANALYST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALKA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:732-886-8113
Mailing Address - Street 1:126 MELVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4235
Mailing Address - Country:US
Mailing Address - Phone:732-886-8113
Mailing Address - Fax:
Practice Address - Street 1:685 E 7TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5903
Practice Address - Country:US
Practice Address - Phone:732-886-8113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty