Active NPI
Michele J Ebert, MSED
- Behavior Analyst
- Mastic Beach, NY
National Provider Identifier
1972866986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1110949
- Practice address
- 14 Bogota Rd
Mastic Beach, NY 11951-5802 - Phone
- (516) 359-2134
- NPI assigned
- Jun 25, 2012
- 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 | 1110949 | NY | Primary |
Addresses
Primary practice location
14 Bogota Rd
Mastic Beach, NY 11951-5802
Mailing address
14 Bogota Road
Mastic Beach, NY 11951-5802
Phone (516) 359-2134
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1110949 | NY | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340582400000",
"number": "1972866986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 BOGOTA ROAD",
"city": "MASTIC BEACH",
"state": "NY",
"postal_code": "119515802",
"telephone_number": "516-359-2134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 BOGOTA RD",
"city": "MASTIC BEACH",
"state": "NY",
"postal_code": "119515802",
"telephone_number": "516-359-2134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBERT",
"first_name": "MICHELE",
"middle_name": "J",
"credential": "MSED",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-25",
"last_updated": "2012-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NY",
"license": "1110949",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mastic Beach, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.