1093232357 NPI number — LEA MICHELLE ZELLERS MS ED, MS SPED

Table of content: LEA MICHELLE ZELLERS MS ED, MS SPED (NPI 1093232357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093232357 NPI number — LEA MICHELLE ZELLERS MS ED, MS SPED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZELLERS
Provider First Name:
LEA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS ED, MS SPED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLEISCHMAN
Provider Other First Name:
LEA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS ED, MS SPED
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093232357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10818 QUEENS BLVD STE 4A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-4748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 CRESCENT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASTIC
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11950-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-922-1090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  2529567 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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