=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164731402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADLER SPECIAL CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2010
-----------------------------------------------------
Last Update Date | 10/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 138-18 228 STREET
-----------------------------------------------------
City | LAURELTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-886-8932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13818 228TH ST
-----------------------------------------------------
City | LAURELTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11413-2843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-886-8932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. HANTZ MAXIME
-----------------------------------------------------
Credential | OTR
-----------------------------------------------------
Telephone | 347-886-8932
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251T00000X
-----------------------------------------------------
Taxonomy Name | PACE Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------