1295964898 NPI number — ISRAELSHINING STAR INCORPORATED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295964898 NPI number — ISRAELSHINING STAR INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISRAELSHINING STAR INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295964898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 900093
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAR ROCKAWAY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11690-0093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-759-8594
Provider Business Mailing Address Fax Number:
718-960-7437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106-35 154TH STREET
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11433-1917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-759-8594
Provider Business Practice Location Address Fax Number:
718-960-7437
Provider Enumeration Date:
07/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ISRAEL
Authorized Official First Name:
NAOMI
Authorized Official Middle Name:
PLEASANT
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
718-759-8495

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  2205381 , 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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