ABA Bedrock VA LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

ABA BEDROCK VA LLC

Practice address

999 Waterside Dr Ste 25252600
Norfolk, VA 23510-3300

Phone

(347) 461-0983

NPI assigned

Nov 25, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mayer Kulefsky

Title

Coo

Phone

(347) 461-0983

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1992521967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 WATERSIDE DR STE 25252600",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235103300",
            "telephone_number": "347-461-0983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 WATERSIDE DR STE 25252600",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235103300",
            "telephone_number": "347-461-0983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABA BEDROCK VA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-25",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "KULEFSKY",
        "authorized_official_first_name": "MAYER",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "347-461-0983"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.