Provider Demographics
NPI:1053764142
Name:ALLEVA DEVELOPMENTAL SERVICES
Entity type:Organization
Organization Name:ALLEVA DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:917-817-4451
Mailing Address - Street 1:777 AVENUE OF THE AMERICAS
Mailing Address - Street 2:30F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6318
Mailing Address - Country:US
Mailing Address - Phone:917-817-4451
Mailing Address - Fax:
Practice Address - Street 1:777 AVENUE OF THE AMERICAS
Practice Address - Street 2:30F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6318
Practice Address - Country:US
Practice Address - Phone:917-817-4451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency