Provider Demographics
NPI:1225378342
Name:FUNCTIONAL LIFE ACHIEVEMENT, INC
Entity type:Organization
Organization Name:FUNCTIONAL LIFE ACHIEVEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST CFY
Authorized Official - Prefix:MISS
Authorized Official - First Name:ZARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUFOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-618-9050
Mailing Address - Street 1:2749 MILL AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:236 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2704
Practice Address - Country:US
Practice Address - Phone:917-618-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency