Provider Demographics
NPI:1982377297
Name:DIFFO DS CORP.
Entity type:Organization
Organization Name:DIFFO DS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL ED TEACHER
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS SP ED
Authorized Official - Phone:718-775-5096
Mailing Address - Street 1:3020 LAWTON AVE PH
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3425
Mailing Address - Country:US
Mailing Address - Phone:718-775-5096
Mailing Address - Fax:
Practice Address - Street 1:3020 LAWTON AVE PH
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-3425
Practice Address - Country:US
Practice Address - Phone:718-775-5096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1194088138Medicaid