MEDICARE: SG INTERVENTION 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	:	1467240861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SG INTERVENTION LLC

Provider Business Mailing Address
First Line	:	4515 12TH AVE APT D5
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2007
Country	:	US
Telephone Number	:	917-618-4187
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 12TH AVE APT D5
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2007
Country	:	US
Telephone Number	:	917-618-4187
Fax Number	:

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	GITTY FRIEDMAN
Credential	:	MSED
Telephone Number	:	917-618-4187

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	04/28/2025

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Directions to “SG INTERVENTION LLC ” Practice Location

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