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General NPI Number Information
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NPI Number | 1205190725
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Entity Type | Organization
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Legal Business Name | A B A PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 79 OAKDALE ST
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City | STATEN ISLAND
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State | NY
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Zip | 10308-2603
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Country | US
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Telephone | 718-967-2242
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Fax |
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Provider Business Mailing Address
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Address Line | 79 OAKDALE ST
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City | STATEN ISLAND
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State | NY
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Zip | 10308-2603
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Country | US
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Telephone | 718-967-2242
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JEANINE CARLSON
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Credential | M.S.ED.
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Telephone | 347-236-1340
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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 |
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License Number State |
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