MEDICARE: MOVING FORWARD LEAPS LLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1720342264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOVING FORWARD LEAPS LLC

Provider Business Mailing Address
First Line	:	PO BOX 434
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-0434
Country	:	US
Telephone Number	:	917-304-1696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2837 W 30TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1803
Country	:	US
Telephone Number	:	917-304-1696
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ARETHA WADE
Credential	:	M.S. ED
Telephone Number	:	917-304-1696

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	03/12/2024

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Directions to “MOVING FORWARD LEAPS LLC ” Practice Location

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