MEDICARE: EARLY IMPACT THERAPY LLC

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	:	1417800327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLY IMPACT THERAPY LLC

Provider Business Mailing Address
First Line	:	4 TAMARACK LN
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-2010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 TAMARACK LN
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-2010
Country	:	US
Telephone Number	:	347-339-1123
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	HANNAH ISKHAKOV
Credential	:
Telephone Number	:	347-339-1123

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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Directions to “EARLY IMPACT THERAPY LLC ” Practice Location

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