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General NPI Number Information
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NPI Number | 1225378342
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL LIFE ACHIEVEMENT, INC
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Dates
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Enumeration Date | 02/26/2013
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 236 2ND AVE
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City | NEW YORK
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State | NY
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Zip | 10003-2704
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Country | US
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Telephone | 917-618-9050
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Fax |
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Provider Business Mailing Address
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Address Line | 2749 MILL AVE FL 2
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City | BROOKLYN
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State | NY
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Zip | 11234-6421
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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 | SPEECH PATHOLOGIST CFY
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Name | MISS ZARINA YUSUFOV
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Credential |
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Telephone | 917-618-9050
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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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