MEDICARE: PHASE PIGGY BACK, 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	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588961122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHASE PIGGY BACK, INC

Provider Business Mailing Address
First Line	:	266 WEST 145TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-4104
Country	:	US
Telephone Number	:	212-690-4002
Fax Number	:	212-690-3264

Provider Business Practice Location Address
First Line	:	266 W 145TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-4104
Country	:	US
Telephone Number	:	212-690-4002
Fax Number	:	212-690-3264

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JOANNA FIGUEROA
Credential	:
Telephone Number	:	212-690-4002

Provider Enumeration Date	:	02/17/2011
Last Update Date	:	02/17/2011

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Directions to “PHASE PIGGY BACK, INC ” Practice Location

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