MEDICARE: EDUGENIX, 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

General Provider Information

NPI Number	:	1609624030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUGENIX, INC.

Provider Business Mailing Address
First Line	:	3376 SHORE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3075
Country	:	US
Telephone Number	:	646-733-6068
Fax Number	:

Provider Business Practice Location Address
First Line	:	3376 SHORE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3075
Country	:	US
Telephone Number	:	646-733-6068
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ANASTASIA ANDREYEVA
Credential	:	MSPED
Telephone Number	:	646-733-6068

Provider Enumeration Date	:	05/09/2024
Last Update Date	:	05/09/2024

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Directions to “EDUGENIX, INC. ” Practice Location

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