Provider Demographics
NPI:1922510676
Name:PRODIGY OF NEW YORK, INC.
Entity Type:Organization
Organization Name:PRODIGY OF NEW YORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHER/OWENER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MSED
Authorized Official - Phone:917-804-3564
Mailing Address - Street 1:75 W 238TH ST APT 1K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4270
Mailing Address - Country:US
Mailing Address - Phone:917-804-3564
Mailing Address - Fax:
Practice Address - Street 1:75 W 238TH ST APT 1K
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4270
Practice Address - Country:US
Practice Address - Phone:917-804-3564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management