Provider Demographics
NPI:1831466598
Name:JUMPSTART EARLY INTERVENTION PROGRAM
Entity Type:Organization
Organization Name:JUMPSTART EARLY INTERVENTION PROGRAM
Other - Org Name:WOMENS LEAGUE COMMUNITY RESIDENCES
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TSIREL
Authorized Official - Middle Name:
Authorized Official - Last Name:WINOGRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-853-7900
Mailing Address - Street 1:1835 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2809
Mailing Address - Country:US
Mailing Address - Phone:646-401-1741
Mailing Address - Fax:
Practice Address - Street 1:1835 E 15TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2809
Practice Address - Country:US
Practice Address - Phone:646-401-1741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
123-38-7338-TOtherMEDICARE CLAIM NUMBER