Healthcare Provider Details

I. General information

NPI: 1528528049
Provider Name (Legal Business Name): LITTLE WONDER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8866 MYRTLE AVE
GLENDALE NY
11385-7857
US

IV. Provider business mailing address

8866 MYRTLE AVE
GLENDALE NY
11385-7857
US

V. Phone/Fax

Practice location:
  • Phone: 178-850-0400
  • Fax: 718-805-1790
Mailing address:
  • Phone: 178-850-0400
  • Fax: 718-805-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: SABIN SHAHID
Title or Position: SERVICE CORDINATOR
Credential:
Phone: 718-850-0400