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1952276065 NPI number — FIESTA ADULT DAYCARE LLC

NPI Number: 1952276065
Health Care Provider/Practitioner: FIESTA ADULT DAYCARE LLC

Information about “1952276065” NPI (FIESTA ADULT DAYCARE LLC) exists in 1952276065 in HTML format HTML  |  1952276065 in plain Text format TXT  |  1952276065 in PDF (Portable Document Format) PDF  |  1952276065 in an XML format XML  formats.

NPI Number : 1952276065 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952276065",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FIESTA ADULT DAYCARE LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2200 VICTORY BLVD FL 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STATEN ISLAND",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10314-6624",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "718-814-0555",
    "MailingAddressFaxNumber": "718-228-8999",
    "FirstLinePracticeLocationAddress": "2200 VICTORY BLVD FL 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STATEN ISLAND",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10314-6624",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "718-814-0555",
    "PracticeLocationAddressFaxNumber": "718-228-8999",
    "EnumerationDate": "10/08/2025",
    "LastUpdateDate": "10/08/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ELBERG",
    "AuthorizedOfficialFirstName": "TATYANA",
    "AuthorizedOfficialMiddleName": "F",
    "AuthorizedOfficialTitle": "ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "718-996-0456",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QA0600X",
        "TaxonomyName": "Adult Day Care Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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