Provider Demographics
NPI:1902665987
Name:SPROUTING TEE MOON LLC
Entity Type:Organization
Organization Name:SPROUTING TEE MOON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:516-668-3792
Mailing Address - Street 1:70 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-4108
Mailing Address - Country:US
Mailing Address - Phone:516-668-4792
Mailing Address - Fax:
Practice Address - Street 1:70 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-4108
Practice Address - Country:US
Practice Address - Phone:516-668-4792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency