Healthcare Provider Details

I. General information

NPI: 1053717272
Provider Name (Legal Business Name): STEPHANIE TIWARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2014
Last Update Date: 11/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6143 186TH ST
FRESH MEADOWS NY
11365-2710
US

IV. Provider business mailing address

6143 186TH ST
FRESH MEADOWS NY
11365-2710
US

V. Phone/Fax

Practice location:
  • Phone: 347-506-3986
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number091497
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: