Provider Demographics
NPI:1689388084
Name:OMNI CHILDHOOD REHAB
Entity Type:Organization
Organization Name:OMNI CHILDHOOD REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EI DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BABIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L MED
Authorized Official - Phone:646-229-1433
Mailing Address - Street 1:2218 OCEAN AVE PH 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2280
Mailing Address - Country:US
Mailing Address - Phone:347-245-9899
Mailing Address - Fax:
Practice Address - Street 1:2218 OCEAN AVE PH 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2280
Practice Address - Country:US
Practice Address - Phone:347-245-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency