Provider Demographics
NPI:1639593098
Name:KINDERKARE EARLY INTERVENTION PROGRAM
Entity Type:Organization
Organization Name:KINDERKARE EARLY INTERVENTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUSCALDO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:347-834-2755
Mailing Address - Street 1:63 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1209
Mailing Address - Country:US
Mailing Address - Phone:347-834-2755
Mailing Address - Fax:
Practice Address - Street 1:63 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1209
Practice Address - Country:US
Practice Address - Phone:347-834-2755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency