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General NPI Number Information
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NPI Number | 1609209295
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Entity Type | Organization
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Legal Business Name | ASTOR HEADSTART
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 6339 MILL ST
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City | RHINEBECK
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State | NY
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Zip | 12572-1427
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Country | US
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Telephone | 845-838-9904
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Fax |
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Provider Business Mailing Address
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Address Line | 101 TOMPKINS TER
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City | BEACON
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State | NY
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Zip | 12508-1608
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Country | US
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Telephone | 845-765-1345
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | RANDIE MARIE GERENA
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Credential |
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Telephone | 845-765-1345
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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 | 284778-1
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License Number State | NY
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