Provider Demographics
NPI:1487830113
Name:AGES & STAGES , LLP
Entity type:Organization
Organization Name:AGES & STAGES , LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:SWIAT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-692-4391
Mailing Address - Street 1:192 TOWER DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-2056
Mailing Address - Country:US
Mailing Address - Phone:845-692-4391
Mailing Address - Fax:845-692-4397
Practice Address - Street 1:192 TOWER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-2056
Practice Address - Country:US
Practice Address - Phone:845-692-4391
Practice Address - Fax:845-692-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03260620Medicaid