Provider Demographics
NPI:1639937436
Name:FULL CIRCLE EIP INC
Entity Type:Organization
Organization Name:FULL CIRCLE EIP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YULIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGIDULLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MSSPEED
Authorized Official - Phone:929-434-4334
Mailing Address - Street 1:2675 OCEAN AVE APT 6A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4615
Mailing Address - Country:US
Mailing Address - Phone:929-434-4334
Mailing Address - Fax:
Practice Address - Street 1:2675 OCEAN AVE APT 6A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4615
Practice Address - Country:US
Practice Address - Phone:929-434-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management