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General NPI Number Information
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NPI Number | 1225445679
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Entity Type | Individual
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Provider Name | SHANI IMRE M.S SPED
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Gender | Female
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 9707 63RD RD APT 9L
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City | REGO PARK
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State | NY
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Zip | 11374-1607
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Country | US
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Telephone | 917-480-0276
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Fax |
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Provider Business Mailing Address
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Address Line | 9707 63RD RD APT 9L
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City | REGO PARK
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State | NY
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Zip | 11374-1607
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1182852
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License Number State | NY
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