MEDICARE: ADEMI INC

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	:	1780051284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADEMI INC

Provider Business Mailing Address
First Line	:	8636 23RD AVE
Second Line	:	APT. 1F
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4226
Country	:	US
Telephone Number	:	917-655-1850
Fax Number	:

Provider Business Practice Location Address
First Line	:	8636 23RD AVE
Second Line	:	APT. 1F
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4226
Country	:	US
Telephone Number	:	917-655-1850
Fax Number	:

Authorized Official
Title or Position	:	INCORPORATOR
Name	:	MRS. MAIA MATCHARASHVILI
Credential	:	M.S.ED
Telephone Number	:	917-655-1850

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	08/31/2015

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