Organization
EARLY CHILDHOOD INTERVENTION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA SIMS (DIRECTOR)
(718) 344-4508
Entity
Organization
Contact information
Practice address
14483 176TH ST, JAMAICA, NY 11434-4913
(718) 977-0110
Mailing address
14483 176TH ST, JAMAICA, NY 11434-4913
(718) 977-0110
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
58014667
NY
305S00000X
Point of Service
58-017019
NY
Other
Enumeration date
10/06/2010
Last updated
10/06/2010
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