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General NPI Number Information
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NPI Number | 1609226240
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Entity Type | Organization
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Legal Business Name | EARLY SPECTRUM SERVICES, LLC
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 510 2ND AVE 3-C
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City | NEW YORK
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State | NY
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Zip | 10016-8639
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Country | US
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Telephone | 917-573-4489
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Fax | 212-275-8223
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Provider Business Mailing Address
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Address Line | 510 2ND AVE 3-C
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City | NEW YORK
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State | NY
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Zip | 10016-8639
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Country | US
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Telephone | 917-573-4489
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Fax | 212-275-8223
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KENNETH SCOTT
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Credential |
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Telephone | 212-275-8223
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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 | 721496
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License Number State | NY
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