MEDICARE: SURESTEP, 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	013785	NY

General Provider Information

NPI Number	:	1518230705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURESTEP, INC

Provider Business Mailing Address
First Line	:	3847 POPLAR AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1301
Country	:	US
Telephone Number	:	718-449-0503
Fax Number	:

Provider Business Practice Location Address
First Line	:	3847 POPLAR AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1301
Country	:	US
Telephone Number	:	718-449-0503
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HELENA PERETS
Credential	:	MS, CCC-SLP
Telephone Number	:	718-449-0503

Provider Enumeration Date	:	02/17/2012
Last Update Date	:	02/17/2012

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Directions to “SURESTEP, INC ” Practice Location

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