1508171059 NPI number — ESPECIAL EDUCATION ASSOCIATES

Table of content: (NPI 1508171059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508171059 NPI number — ESPECIAL EDUCATION ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESPECIAL EDUCATION ASSOCIATES
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:
ESPECIAL EDUCATION ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1508171059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1128 E 84TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11236-4733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-782-7230
Provider Business Mailing Address Fax Number:
718-376-5506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 AVENUE P
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-376-5510
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JOSEPH
Authorized Official First Name:
EDDY
Authorized Official Middle Name:
Authorized Official Title or Position:
SPECIAL EDUCATION TEACHER
Authorized Official Telephone Number:
347-782-7230

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  091665152 , 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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