MEDICARE: GOOD LUCK TR.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	:	1629318837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD LUCK TR.INC

Provider Business Mailing Address
First Line	:	11 OCEAN CT
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6045
Country	:	US
Telephone Number	:	646-637-8001
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 OCEAN CT
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6045
Country	:	US
Telephone Number	:	646-637-8001
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DANIEL VERNIKOV
Credential	:
Telephone Number	:	646-637-8001

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	02/25/2013

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Directions to “GOOD LUCK TR.INC ” Practice Location

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