1245778844 NPI number — A PLACE FOR MY SPECIAL NEEDS EARLY INTERVENTION

Table of content: MARY L GAYDEN LIC PRACTICAL NURSE (NPI 1720246598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245778844 NPI number — A PLACE FOR MY SPECIAL NEEDS EARLY INTERVENTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A PLACE FOR MY SPECIAL NEEDS EARLY INTERVENTION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245778844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 CLARKE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11717-2002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-434-6665
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 CLARKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11717-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-434-6665
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKITT
Authorized Official First Name:
AKEESHA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
631-434-6665

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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