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General NPI Number Information
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NPI Number | 1508134305
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Entity Type | Organization
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Legal Business Name | PREMIER PROVIDERS INC.
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 103 82ND RD
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City | KEW GARDENS
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State | NY
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Zip | 11415-1422
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Country | US
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Telephone | 917-669-1991
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Fax | 718-360-8957
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Provider Business Mailing Address
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Address Line | 103 82ND RD
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City | KEW GARDENS
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State | NY
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Zip | 11415
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Country | US
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Telephone | 917-669-1991
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Fax | 718-360-8957
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MISS TASHANA F MOHABIR
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Credential | MS.CCC-SLP
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Telephone | 917-669-1991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 0614371
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License Number State | NY
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