Healthcare Provider Details

I. General information

NPI: 1962367581
Provider Name (Legal Business Name): 1111 A BABY'S WISH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 BROADWAY
NEW YORK NY
10013-2562
US

IV. Provider business mailing address

447 BROADWAY
NEW YORK NY
10013-2562
US

V. Phone/Fax

Practice location:
  • Phone: 917-719-1606
  • Fax: 833-354-0977
Mailing address:
  • Phone: 917-719-1606
  • Fax: 833-354-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYNETTE BRITTANY MILLS-NEVILLS
Title or Position: C.E.O/FOUNDER
Credential: MSFP
Phone: 917-727-0799