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General NPI Number Information
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NPI Number | 1881410041
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Entity Type | Organization
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Legal Business Name | GOOD LIFE ADVANCEMENT AND DEVELOPMENT INC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 65 MARINE WAY FL 2
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City | STATEN ISLAND
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State | NY
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Zip | 10306-5733
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Country | US
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Telephone | 646-541-3424
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Fax |
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Provider Business Mailing Address
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Address Line | 65 MARINE WAY FL 2
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City | STATEN ISLAND
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State | NY
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Zip | 10306-5733
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Country | US
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Telephone | 646-541-3424
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. VERONICA BAKHRAKH
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Credential | MSED/SP.ED.
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Telephone | 646-541-3424
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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 |
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License Number State |
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