# ILLIASSA INC

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

## Provider details

- **NPI number:** 1447610290
- **Authorized official:** TAMBA SINGHATEH (PRESIDENT)
- **Authorized official phone:** (646) 270-5436

## Contact information

- **Practice address:** 2139 WASHINGTON AVE, BRONX, NY 10457-2553
- **Practice address phone:** (646) 270-5436
- **Practice address fax:** (718) 901-3739
- **Mailing address:** 2139 WASHINGTON AVE, BRONX, NY 10457-2553
- **Mailing address phone:** (646) 270-5436
- **Mailing address fax:** (718) 901-3739

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | 751806 | NY | Yes |

## Other

- **Enumeration date:** 03/07/2016
- **Last updated:** 03/07/2016