MEDICARE: S&M17 INC

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	:	1326676107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S&M17 INC

Provider Business Mailing Address
First Line	:	2790 W 5TH ST APT 11E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4125
Country	:	US
Telephone Number	:	917-531-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2790 W 5TH ST APT 11E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4125
Country	:	US
Telephone Number	:	917-531-4800
Fax Number	:

Authorized Official
Title or Position	:	EARLY INTERVENNTIONIST
Name	:	MARLEEN ZHIK
Credential	:
Telephone Number	:	917-531-4800

Provider Enumeration Date	:	03/29/2020
Last Update Date	:	10/23/2020

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Directions to “S&M17 INC ” Practice Location

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