1750804951 NPI number — IRI: INNOVATIVE RESOURCES FOR INDEPENDENCE

Table of content: (NPI 1750804951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750804951 NPI number — IRI: INNOVATIVE RESOURCES FOR INDEPENDENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRI: INNOVATIVE RESOURCES FOR INDEPENDENCE
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:
1750804951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112-40 FRANCIS LEWIS BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEENS VILLAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11429-2235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-805-6796
Provider Business Mailing Address Fax Number:
718-776-2724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
922 RAINBOW COMMONS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-805-6796
Provider Business Practice Location Address Fax Number:
718-776-3858
Provider Enumeration Date:
07/19/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAGALEE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSOCIATE EXECUTIVE DIR OF ADMIN
Authorized Official Telephone Number:
718-805-6796

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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