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General NPI Number Information
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NPI Number | 1134503923
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Entity Type | Organization
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Legal Business Name | VT'S ABC INC.
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Dates
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Enumeration Date | 07/12/2015
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Last Update Date | 07/12/2015
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Provider Practice Location Address
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Address Line | 58 WESTWOOD AVE
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City | DEER PARK
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State | NY
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Zip | 11729-2211
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Country | US
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Telephone | 631-902-2530
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Fax | 631-667-0235
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Provider Business Mailing Address
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Address Line | 58 WESTWOOD AVE
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City | DEER PARK
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State | NY
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Zip | 11729-2211
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Country | US
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Telephone | 631-902-2530
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Fax | 631-667-0235
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Authorized Official
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Title or Position | SPECIAL EDUCATOR
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Name | MS. VIBHA TYAGI
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Credential | MS.ED
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Telephone | 631-902-2530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 773981
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License Number State | NY
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