=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407232135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRO MED STAFFING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2015
-----------------------------------------------------
Last Update Date | 08/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8784 257TH ST
-----------------------------------------------------
City | FLORAL PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11001-1416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-730-4331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8784 257TH ST
-----------------------------------------------------
City | FLORAL PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11001-1416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-730-4331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED NURSE
-----------------------------------------------------
Name | MRS. BETTY SANTOSH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-730-4331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | 585844-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------