MEDICARE: EAST COAST RESEARCH & LEARNING INSTITUTE

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
2	252Y00000X	Early Intervention Provider Agency		NY

General Provider Information

NPI Number	:	1720337041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST COAST RESEARCH & LEARNING INSTITUTE

Provider Business Mailing Address
First Line	:	10-31 48TH AVENUE
Second Line	:	STREET LEVEL
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5607
Country	:	US
Telephone Number	:	347-617-2099
Fax Number	:

Provider Business Practice Location Address
First Line	:	10-31 48TH AVENUE
Second Line	:	STREET LEVEL
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5607
Country	:	US
Telephone Number	:	347-617-2099
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. CECILIA KILAYKO GULLAS
Credential	:	R.N.
Telephone Number	:	347-617-2099

Provider Enumeration Date	:	08/31/2012
Last Update Date	:	01/08/2013

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