Healthcare Provider Details

I. General information

NPI: 1508171059
Provider Name (Legal Business Name): ESPECIAL EDUCATION ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 AVENUE P
BROOKLYN NY
11236
US

IV. Provider business mailing address

1128 E 84TH ST
BROOKLYN NY
11236-4733
US

V. Phone/Fax

Practice location:
  • Phone: 718-376-5510
  • Fax:
Mailing address:
  • Phone: 347-782-7230
  • Fax: 718-376-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number091665152
License Number StateNY

VIII. Authorized Official

Name: MR. EDDY JOSEPH
Title or Position: SPECIAL EDUCATION TEACHER
Credential: M.S
Phone: 347-782-7230