MEDICARE: CANARSIE EIP, 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	38100	NY

General Provider Information

NPI Number	:	1508011545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANARSIE EIP, INC.

Provider Business Mailing Address
First Line	:	1651 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3317
Country	:	US
Telephone Number	:	718-241-9211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3317
Country	:	US
Telephone Number	:	718-241-9211
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. ELIOT KIRSCHENBAUM
Credential	:	PSYD
Telephone Number	:	718-241-9211

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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