Provider Demographics
NPI:1508697913
Name:MOMENTUM ABA LICENSED BEHAVIOR ANALYST SERVICES PLLC
Entity type:Organization
Organization Name:MOMENTUM ABA LICENSED BEHAVIOR ANALYST SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQUI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:516-233-7886
Mailing Address - Street 1:1225 FRANKLIN AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1693
Mailing Address - Country:US
Mailing Address - Phone:516-233-7886
Mailing Address - Fax:
Practice Address - Street 1:1225 FRANKLIN AVE STE 325
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1693
Practice Address - Country:US
Practice Address - Phone:516-233-7886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty