Organization
YAI/NYL/LIFESTART
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NANCY PETRUCELLI MAED (COORDINATOR LIFESTART PROGRAM)
(212) 418-0320
Entity
Organization
Contact information
Practice address
130 VOIGHT AVE, BRIDGEPORT, CT 06606-1538
(347) 432-1164
Mailing address
130 VOIGHT AVE, BRIDGEPORT, CT 06606-1538
(347) 432-1164
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
80895071
NY
252Y00000X
Early Intervention Provider Agency
80901071
NY
Other
Enumeration date
06/12/2012
Last updated
06/12/2012
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