Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | NY |
NPI | 1003216854 |
---|---|
Provider Name | Elliott Marx |
First Address | Bellmore, NY 11710-5730 |
Second Address | Bellmore, NY 11710-5730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2014 |
Last Update Date | 29/08/2014 |