Active NPI
Alexandra Wild, MS, BCBA
- Behavior Analyst
- Farmingdale, NY
National Provider Identifier
1679186159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 500 Bi County Blvd Ste 450
Farmingdale, NY 11735-3995 - Phone
- (631) 388-7813
- NPI assigned
- Aug 25, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
500 Bi County Blvd Ste 450
Farmingdale, NY 11735-3995
Mailing address
630 Shore Rd Apt 322
Long Beach, NY 11561-4620
Phone (631) 987-0089
Other practice location 1
630 Shore Rd Apt 322
Long Beach, NY 11561-4620
Phone (631) 987-0089
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VQA483M92106 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1679186159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 SHORE RD APT 322",
"city": "LONG BEACH",
"state": "NY",
"postal_code": "115614620",
"telephone_number": "631-987-0089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 BI COUNTY BLVD STE 450",
"city": "FARMINGDALE",
"state": "NY",
"postal_code": "117353995",
"telephone_number": "631-388-7813"
}
],
"practiceLocations": [
{
"address_1": "630 Shore Rd Apt 322",
"address_purpose": "LOCATION",
"city": "Long Beach",
"state": "NY",
"postal_code": "115614620",
"country_code": "US",
"telephone_number": "631-987-0089",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILD",
"first_name": "ALEXANDRA",
"credential": "MS, BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-25",
"last_updated": "2023-11-27",
"certification_date": "2023-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "VQA483M92106",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Farmingdale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.