=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780077651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUTSTANDING CHILDREN INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2015
-----------------------------------------------------
Last Update Date | 03/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15159 22ND AVE
-----------------------------------------------------
City | WHITESTONE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11357-3718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-960-1123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 570647
-----------------------------------------------------
City | WHITESTONE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11357-0647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-960-1123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. LAURA FITZPATRICK
-----------------------------------------------------
Credential | MSED
-----------------------------------------------------
Telephone | 631-960-1123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 654436121
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------