Healthcare Provider Details

I. General information

NPI: 1447405121
Provider Name (Legal Business Name): LIFESTART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2008
Last Update Date: 11/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E 23RD ST APT 14 L
NEW YORK NY
10010-4713
US

IV. Provider business mailing address

320 E 23RD ST APT 14 L
NEW YORK NY
10010-4713
US

V. Phone/Fax

Practice location:
  • Phone: 212-991-5510
  • Fax:
Mailing address:
  • Phone: 212-991-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number017284-1
License Number StateNY

VIII. Authorized Official

Name: CHRIS LIANNI LANNI
Title or Position: CLINICAL SUPERVISOR
Credential:
Phone: 646-291-8383