MEDICARE: ACT ON IT EARLY INTERVENTION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1003326265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACT ON IT EARLY INTERVENTION

Provider Business Mailing Address
First Line	:	7515 MAIN ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-2420
Country	:	US
Telephone Number	:	718-213-3140
Fax Number	:	929-244-7107

Provider Business Practice Location Address
First Line	:	7515 MAIN ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-2420
Country	:	US
Telephone Number	:	718-213-3140
Fax Number	:	929-244-7107

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	ROXANE PINKHASOV
Credential	:
Telephone Number	:	718-213-3140

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	01/17/2022

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Directions to “ACT ON IT EARLY INTERVENTION ” Practice Location

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