| NPI | 1154664886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA KALIETA Provider Relations Manager 631-835-7780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2013-04-01 |