Individual
ESRA NUR USTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 BROADHOLLOW RD STE 402, MELVILLE, NY 11747-4899
(631) 385-7780
(631) 385-7795
Mailing address
305 BROADWAY, WEST BABYLON, NY 11704-5646
(631) 671-7055
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/06/2021
Last updated
08/06/2021
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