=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043527641
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIME TIME CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2010
-----------------------------------------------------
Last Update Date | 09/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13844 JEWEL AVE
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-1933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-263-3455
-----------------------------------------------------
Fax | 718-263-2340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13844 JEWEL AVE
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-1933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-263-3455
-----------------------------------------------------
Fax | 718-263-2340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. MARCY SCHAFFER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 718-263-3455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------