# LB411

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376807222
- **Authorized official:** ISABELLA DEANGELIS (TSHH, MS. ED.)
- **Authorized official phone:** (347) 579-8474

## Contact information

- **Practice address:** 370 SAND LN, STATEN ISLAND, NY 10305-4551
- **Practice address phone:** (347) 579-8474
- **Mailing address:** 370 SAND LN, STATEN ISLAND, NY 10305-4551

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | 052747980 | NY | Yes |

## Other

- **Enumeration date:** 06/26/2012
- **Last updated:** 06/26/2012