MEDICARE: VRT CONSULTING 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1780285122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VRT CONSULTING LLC

Provider Business Mailing Address
First Line	:	3150 41ST ST APT 4F
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-3906
Country	:	US
Telephone Number	:	610-937-1983
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 41ST ST APT 4F
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-3906
Country	:	US
Telephone Number	:	610-937-1983
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CEO
Name	:	ALYSSA JANE GERSONY
Credential	:	MS ED, COMS, CVRT
Telephone Number	:	610-937-1983

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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