1801519756 NPI number — MS. CHEVANESE V GRANT MS SPECIAL EDUCATION

Table of content: MS. CHEVANESE V GRANT MS SPECIAL EDUCATION (NPI 1801519756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801519756 NPI number — MS. CHEVANESE V GRANT MS SPECIAL EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT
Provider First Name:
CHEVANESE
Provider Middle Name:
V
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS SPECIAL EDUCATION
Provider Gender Code:
F

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:
1801519756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 GLENWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ROCHELLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10801-3602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-336-1512
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1336 LOUIS NINE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10459-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-991-2119
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2022

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: 103K00000X , with the licence number:  2588463 , 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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