Over the Moon Enrichment Agency

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

OVER THE MOON ENRICHMENT AGENCY

Practice address

61 A Main Street
Pine Bush, NY 12566

Phone

(845) 524-4411

NPI assigned

Dec 7, 2015

Last updated

Dec 7, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Suzanne Russell

Title

Owner/Ei Program Director

Phone

(845) 524-4411

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449446400000",
    "number": "1902271620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1201",
            "city": "PINE BUSH",
            "state": "NY",
            "postal_code": "12566",
            "telephone_number": "845-524-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 A MAIN STREET",
            "city": "PINE BUSH",
            "state": "NY",
            "postal_code": "12566",
            "telephone_number": "845-524-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OVER THE MOON ENRICHMENT AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-07",
        "last_updated": "2015-12-07",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "OWNER/EI PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "845-524-4411",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.