Provider Demographics
NPI:1861673006
Name:PEDIATRIC EARLY DEVELOPMENT SERVICES, OT, PC
Entity Type:Organization
Organization Name:PEDIATRIC EARLY DEVELOPMENT SERVICES, OT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASBUN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:917-584-7671
Mailing Address - Street 1:1208 154TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1957
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:718-746-1624
Practice Address - Street 1:1208 154TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1957
Practice Address - Country:US
Practice Address - Phone:917-584-7671
Practice Address - Fax:718-746-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013046-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty