Provider Demographics
NPI:1457901829
Name:PROSPEROUS START
Entity Type:Organization
Organization Name:PROSPEROUS START
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOKHINA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:646-884-3804
Mailing Address - Street 1:150 CORBIN PL APT 5T
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4873
Mailing Address - Country:US
Mailing Address - Phone:646-884-3804
Mailing Address - Fax:
Practice Address - Street 1:150 CORBIN PL APT 5T
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4873
Practice Address - Country:US
Practice Address - Phone:646-884-3804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty