Provider Demographics
NPI:1619601176
Name:EAS108 CORP
Entity Type:Organization
Organization Name:EAS108 CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EARLY INTERVENTION PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-915-0018
Mailing Address - Street 1:200 CORBIN PL APT 4D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4930
Mailing Address - Country:US
Mailing Address - Phone:718-915-0018
Mailing Address - Fax:
Practice Address - Street 1:200 CORBIN PL APT 4D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4930
Practice Address - Country:US
Practice Address - Phone:718-915-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency