MEDICARE: THE RESEARCH FOUNDATION SUNY DOWNSTATE

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	22200	NY

General Provider Information

NPI Number	:	1255641270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RESEARCH FOUNDATION SUNY DOWNSTATE

Provider Business Mailing Address
First Line	:	450 CLARKSON AVE
Second Line	:	BOX 69
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2012
Country	:	US
Telephone Number	:	718-270-1178
Fax Number	:	718-270-1407

Provider Business Practice Location Address
First Line	:	670 PARKSIDE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1506
Country	:	US
Telephone Number	:	718-270-2598
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT VICE PRESIDENT
Name	:	MR. ANTONY A. SELVADURAI
Credential	:
Telephone Number	:	718-270-1178

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	10/08/2010

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