MEDICARE: YAI/NYL/LIFESTART

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	80901071	NY
2	252Y00000X	Early Intervention Provider Agency	80895071	NY

General Provider Information

NPI Number	:	1518229905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YAI/NYL/LIFESTART

Provider Business Mailing Address
First Line	:	130 VOIGHT AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-1538
Country	:	US
Telephone Number	:	347-432-1164
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 VOIGHT AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-1538
Country	:	US
Telephone Number	:	347-432-1164
Fax Number	:

Authorized Official
Title or Position	:	COORDINATOR LIFESTART PROGRAM
Name	:	MS. NANCY PETRUCELLI
Credential	:	MAED
Telephone Number	:	212-418-0320

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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Directions to “YAI/NYL/LIFESTART ” Practice Location

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