=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215367602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENVISION THERAPEUTIC SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2013
-----------------------------------------------------
Last Update Date | 11/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 163 MAPLE AVE
-----------------------------------------------------
City | SPRING VALLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10977-4722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-222-4289
-----------------------------------------------------
Fax | 845-290-5767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 521
-----------------------------------------------------
City | MONSEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10952-0521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-222-4289
-----------------------------------------------------
Fax | 845-290-5767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. SHEINDL HALPERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-222-4289
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------