Organization
PRODIGY OF NEW YORK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TABATHA WILLIAMS BA, MS.ED (TEACHER/OWENER)
(917) 804-3564
Entity
Organization
Contact information
Practice address
75 W 238TH ST APT 1K, BRONX, NY 10463-4270
(917) 804-3564
Mailing address
75 W 238TH ST APT 1K, BRONX, NY 10463-4270
(917) 804-3564
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
11/02/2017
Last updated
11/02/2017
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