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NPI Code Detail

MEDICARE: LITTLE LEADERS OF BROOKLYN CLUB LLC

MEDICARE: LITTLE LEADERS OF BROOKLYN CLUB 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
1252Y00000XEarly Intervention Provider Agency

General Provider Information

NPI Number : 1538614409
Entity Type Code : Organization
Provider Name (Legal Business Name) : LITTLE LEADERS OF BROOKLYN CLUB LLC
Provider Business Mailing Address
First Line : 2547 W 2ND ST
Second Line : 3B
City : BROOKLYN
State : NY
Zip : 11223-6250
Country : US
Telephone Number : 347-495-2724
Fax Number :
Provider Business Practice Location Address
First Line : 2547 W 2ND ST
Second Line : 3B
City : BROOKLYN
State : NY
Zip : 11223-6250
Country : US
Telephone Number : 347-495-2724
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : MISS MARINA KOLMANOVSKY
Credential :
Telephone Number : 347-495-2724
Provider Enumeration Date : 08/22/2016
Last Update Date : 08/22/2016

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