MEDICARE: YELED V YALDA

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1043572449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YELED V YALDA

Provider Business Mailing Address
First Line	:	20 PARK HILL CIR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-3635
Country	:	US
Telephone Number	:	718-720-0090
Fax Number	:	718-720-0280

Provider Business Practice Location Address
First Line	:	20 PARK HILL CIR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-3635
Country	:	US
Telephone Number	:	718-720-0090
Fax Number	:	718-720-0280

Authorized Official
Title or Position	:	DISABILITIES COORDINATOR
Name	:	MISS IRIS JEANNETTE JAIMAN JR.
Credential	:
Telephone Number	:	718-720-0090

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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