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General NPI Number Information
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NPI Number | 1619120060
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Entity Type | Organization
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Legal Business Name | MARATHON INFANTS & TODDLERS, INC.
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 220-18 HORACE HARDING EXP.
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City | BAYSIDE
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State | NY
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Zip | 11364-2227
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Country | US
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Telephone | 718-423-0056
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Fax | 718-229-5370
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Provider Business Mailing Address
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Address Line | 220-18 HORACE HARDING EXP.
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City | BAYSIDE
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State | NY
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Zip | 11364-2227
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Country | US
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Telephone | 718-423-0056
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Fax | 718-229-5370
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. BERNARD ESRIG
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Credential | ED.D.
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Telephone | 718-423-0056
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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 | 41800
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License Number State | NY
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