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General NPI Number Information
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NPI Number | 1578810586
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Entity Type | Organization
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Legal Business Name | STAR EXPRESSIONS
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 9434 222ND ST
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-2008
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Country | US
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Telephone | 516-426-2464
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Fax |
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Provider Business Mailing Address
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Address Line | 30 LORDS WAY
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City | MANHASSET HILLS
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State | NY
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Zip | 11040-1212
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Country | US
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Telephone | 516-426-2464
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Fax |
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Authorized Official
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Title or Position | SPEECH THERAPIST
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Name | MRS. MITZI ABRAHAM
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Credential | CCC-SLP
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Telephone | 516-426-2464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 015655
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License Number State | NY
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