MEDICARE: QUALITY GUIDANCE 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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1619501244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY GUIDANCE INC

Provider Business Mailing Address
First Line	:	40 SHORE BLVD APT 3L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4033
Country	:	US
Telephone Number	:	347-331-9595
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 SHORE BLVD APT 3L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4033
Country	:	US
Telephone Number	:	347-331-9595
Fax Number	:

Authorized Official
Title or Position	:	TEACHER/THERAPIST
Name	:	ANASTASIA BUBYR
Credential	:	MS SP ED
Telephone Number	:	347-331-9595

Provider Enumeration Date	:	02/22/2020
Last Update Date	:	02/22/2020

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