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Organization
OVER THE MOON ENRICHMENT AGENCY
Active
Organization
OVER THE MOON ENRICHMENT AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUZANNE RUSSELL (OWNER/EI PROGRAM DIRECTOR)
(845) 524-4411
Entity
Organization
Contact information
Practice address
61 A MAIN STREET, PINE BUSH, NY 12566
(845) 524-4411
Mailing address
PO BOX 1201, PINE BUSH, NY 12566
(845) 524-4411
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NULL
Other
Enumeration date
12/07/2015
Last updated
12/07/2015
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