Healthcare Provider Details

I. General information

NPI: 1225444557
Provider Name (Legal Business Name): MS. HERMITE MARY LOUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8038 211TH ST
QUEENS VILLAGE NY
11427-1013
US

IV. Provider business mailing address

8038 211TH ST
QUEENS VILLAGE NY
11427-1013
US

V. Phone/Fax

Practice location:
  • Phone: 718-465-4852
  • Fax:
Mailing address:
  • Phone: 718-465-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: