MEDICARE: EARLY LEARNING SUCCESS

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		NY

General Provider Information

NPI Number	:	1174804181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLY LEARNING SUCCESS

Provider Business Mailing Address
First Line	:	984 GREENE AVE APT 1D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-2922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 MYRTLE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3203
Country	:	US
Telephone Number	:	347-898-6964
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TAMMY PIGFORD
Credential	:
Telephone Number	:	347-898-6964

Provider Enumeration Date	:	09/03/2011
Last Update Date	:	07/21/2022

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Directions to “EARLY LEARNING SUCCESS ” Practice Location

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