=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790040566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARION K SALOMON AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2012
-----------------------------------------------------
Last Update Date | 07/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 BOOTH ST
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-7302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-410-1396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 BOOTH ST
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-7302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-410-1396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ABA, SPECIAL EDUCATION TEACHER
-----------------------------------------------------
Name | MS. JESSICA MONE'T VERENE
-----------------------------------------------------
Credential | MS, ABA
-----------------------------------------------------
Telephone | 516-410-1396
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 578727111
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------