=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396116141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUR FAMILIES EARLY INTERVENTIONS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2015
-----------------------------------------------------
Last Update Date | 10/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 358 WADSWORTH AVENUE SUITE #41
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10040-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-776-6305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 358 WADSWORTH AVE APT 41
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10040-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-776-6305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANA ROSA BONIFACIO
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 917-776-6305
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 061068011
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 07074341
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 754355971
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------