Provider Demographics
NPI:1518328962
Name:EARLY INTERVENRION
Entity Type:Organization
Organization Name:EARLY INTERVENRION
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:TEACHER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:516-708-7536
Mailing Address - Street 1:161 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5844
Mailing Address - Country:US
Mailing Address - Phone:516-708-7536
Mailing Address - Fax:
Practice Address - Street 1:161 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-5844
Practice Address - Country:US
Practice Address - Phone:516-708-7536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXXXXXXXXXCCCCCCCCCCC252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency