MEDICARE: CHALLENGE EARLY INTERVENTION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1184986374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHALLENGE EARLY INTERVENTION CENTER

Provider Business Mailing Address
First Line	:	1870-54TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204
Country	:	US
Telephone Number	:	347-404-2620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 54TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1545
Country	:	US
Telephone Number	:	718-702-8054
Fax Number	:

Authorized Official
Title or Position	:	BILINGUAL DEVELOPMENTAL SPECIALIST
Name	:	MRS. REEBA OESTRICH
Credential	:	M.S.
Telephone Number	:	718-851-3401

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	06/13/2012

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