Provider Demographics
NPI:1154788412
Name:EAGLE EYE FV, INC
Entity type:Organization
Organization Name:EAGLE EYE FV, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-864-0977
Mailing Address - Street 1:104 W END AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4952
Mailing Address - Country:US
Mailing Address - Phone:718-332-1119
Mailing Address - Fax:718-332-1139
Practice Address - Street 1:104 W END AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4952
Practice Address - Country:US
Practice Address - Phone:718-332-1119
Practice Address - Fax:718-332-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency