Provider Demographics
NPI:1609418508
Name:MOMENTUM INTERVENTIONS
Entity Type:Organization
Organization Name:MOMENTUM INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-387-7679
Mailing Address - Street 1:12116 POWELLS COVE BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1259
Mailing Address - Country:US
Mailing Address - Phone:646-387-7679
Mailing Address - Fax:
Practice Address - Street 1:12116 POWELLS COVE BLVD APT B
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-1259
Practice Address - Country:US
Practice Address - Phone:646-387-7679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency