Healthcare Provider Details

I. General information

NPI: 1144149600
Provider Name (Legal Business Name): PREMIUM EARLY INTERVENTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GARFIELD RD UNIT 201
MONROE NY
10950-6026
US

IV. Provider business mailing address

2 GARFIELD RD UNIT 201
MONROE NY
10950-6026
US

V. Phone/Fax

Practice location:
  • Phone: 347-675-9285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MOSHE LEVINE
Title or Position: CEO
Credential:
Phone: 347-675-9285