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General NPI Number Information
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NPI Number | 1871274928
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Entity Type | Organization
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Legal Business Name | MINDS WITH PURPOSE
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 1110 SOUTH AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3403
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Country | US
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Telephone | 718-698-6905
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Fax |
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Provider Business Mailing Address
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Address Line | 4 ROMER RD
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City | STATEN ISLAND
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State | NY
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Zip | 10304-1227
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Country | US
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Telephone | 646-464-4884
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. VIKTOR GRINBERG
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Credential | MBA
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Telephone | 646-464-4884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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