Provider Demographics
NPI:1902161649
Name:FUNCTIONAL LIFE ACHIEVEMENT. INK.
Entity Type:Organization
Organization Name:FUNCTIONAL LIFE ACHIEVEMENT. INK.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MEIHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEW
Authorized Official - Suffix:I
Authorized Official - Credentials:MAED
Authorized Official - Phone:212-683-8905
Mailing Address - Street 1:236 2ND AVENUE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-683-8905
Mailing Address - Fax:212-683-8906
Practice Address - Street 1:236 2ND AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2704
Practice Address - Country:US
Practice Address - Phone:212-683-8905
Practice Address - Fax:212-683-8906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicaid