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General NPI Number Information
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NPI Number | 1669734349
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Entity Type | Organization
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Legal Business Name | MIRACLE CHILREN INC.
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 18908 MANGIN AVE
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City | SAINT ALBANS
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State | NY
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Zip | 11412-2320
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Country | US
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Telephone | 347-858-6537
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Fax |
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Provider Business Mailing Address
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Address Line | 18908 MANGIN AVE
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City | SAINT ALBANS
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State | NY
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Zip | 11412-2320
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Country | US
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Telephone | 347-858-6537
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LORNA HOSANG
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Credential | MS. ED.
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Telephone | 347-858-6537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 174847021
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 174847021
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License Number State | NY
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