Provider Demographics
NPI:1841646973
Name:RADUGA, INC.
Entity type:Organization
Organization Name:RADUGA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-915-4404
Mailing Address - Street 1:857 OLYMPIA BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:857 OLYMPIA BLVD
Practice Address - Street 2:UNIT B
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3225
Practice Address - Country:US
Practice Address - Phone:917-915-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY663561121252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency