Provider Demographics
NPI:1629318837
Name:GOOD LUCK TR.INC
Entity Type:Organization
Organization Name:GOOD LUCK TR.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VERNIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-637-8001
Mailing Address - Street 1:11 OCEAN CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6045
Mailing Address - Country:US
Mailing Address - Phone:646-637-8001
Mailing Address - Fax:
Practice Address - Street 1:11 OCEAN CT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6045
Practice Address - Country:US
Practice Address - Phone:646-637-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency