Organization
INTERLINE EAP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROSANNE M MIRANDO (MEDICAL BILLER)
(717) 206-1368
Entity
Organization
Contact information
Practice address
14839 HILLSIDE AVE, JAMAICA, NY 11435-3330
(718) 206-1368
Mailing address
14839 HILLSIDE AVE, JAMAICA, NY 11435-3330
(718) 206-1368
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
01756972
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01756972
—
NY
Enumeration date
04/13/2007
Last updated
10/20/2015
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