MEDICARE: MRS. EILEEN HALLORAN

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		NY

General Provider Information

NPI Number	:	1548524580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EILEEN HALLORAN

Provider Business Mailing Address
First Line	:	201 ANNADALE RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-1537
Country	:	US
Telephone Number	:	917-439-3607
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 ANNADALE RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-1537
Country	:	US
Telephone Number	:	917-439-3607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	06/25/2012

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