Healthcare Provider Details

I. General information

NPI: 1669734208
Provider Name (Legal Business Name): MRS. MIRIAM DEUTSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 RICHMOND AVE SUITE 100
STATEN ISLAND NY
10314-3913
US

IV. Provider business mailing address

1911 RICHMOND AVE SUITE 100
STATEN ISLAND NY
10314-3913
US

V. Phone/Fax

Practice location:
  • Phone: 718-851-3300
  • Fax: 718-370-1597
Mailing address:
  • Phone: 718-851-3300
  • Fax: 718-370-1597

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:
Title or Position:
Credential:
Phone: