Provider Demographics
NPI:1871150227
Name:LITTLE MASTERS DEVELOPMENT CENTER
Entity type:Organization
Organization Name:LITTLE MASTERS DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RADION
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDVEDOVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:MS SPED
Authorized Official - Phone:718-755-1408
Mailing Address - Street 1:8403 CUTHBERT RD APT 1A
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2125
Mailing Address - Country:US
Mailing Address - Phone:718-755-1408
Mailing Address - Fax:347-309-5055
Practice Address - Street 1:155 OCEANA DR E APT 2A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6684
Practice Address - Country:US
Practice Address - Phone:718-755-1408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2024-02-06
Deactivation Date:2024-02-02
Deactivation Code:
Reactivation Date:2024-02-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency