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General NPI Number Information
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NPI Number | 1598031270
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Entity Type | Organization
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Legal Business Name | BOARD OF EDUCATION
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 344 FANNING ST
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City | STATEN ISLAND
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State | NY
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Zip | 10314-5889
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Country | US
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Telephone | 718-477-2434
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Fax | 718-477-2434
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Provider Business Mailing Address
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Address Line | 344 FANNING ST
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City | STATEN ISLAND
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State | NY
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Zip | 10314-5330
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Country | US
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Telephone | 718-477-2434
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Fax | 718-477-2434
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Authorized Official
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Title or Position | NURSE
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Name | MRS. SHINY MARY ABRAHAM
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Credential | RN
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Telephone | 718-946-3491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 546312-1
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License Number State | NY
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