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General NPI Number Information
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NPI Number | 1124364666
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Entity Type | Organization
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Legal Business Name | ISLAND INTERVENTIONS
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Dates
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Enumeration Date | 01/02/2013
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 106 SPRINGDALE DR
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City | RONKONKOMA
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State | NY
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Zip | 11779-5934
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Country | US
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Telephone | 631-521-3548
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Fax |
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Provider Business Mailing Address
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Address Line | 106 SPRINGDALE DR
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City | RONKONKOMA
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State | NY
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Zip | 11779
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RALPH J BARONE
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Credential | BCBA
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Telephone | 631-521-3548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 122482175
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License Number State | NY
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