MEDICARE: AMERIMED EIP

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	1381925	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942562921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERIMED EIP

Provider Business Mailing Address
First Line	:	539 BUEL AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3329
Country	:	US
Telephone Number	:	646-823-4780
Fax Number	:

Provider Business Practice Location Address
First Line	:	539 BUEL AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3329
Country	:	US
Telephone Number	:	646-823-4780
Fax Number	:

Authorized Official
Title or Position	:	TEACHER
Name	:	MRS. ANNA CHIMIREVA
Credential	:	MS ED
Telephone Number	:	646-823-4780

Provider Enumeration Date	:	06/14/2012
Last Update Date	:	06/14/2012

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Directions to “AMERIMED EIP ” Practice Location

Language	Start Address	Practice Location

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