Organization
NEPENTHE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROSANNE M MIRANDO (MEDICAL BILLER)
(631) 243-3056
Entity
Organization
Contact information
Practice address
435 BROOK AVE, UNIT 29, DEER PARK, NY 11729-6829
(631) 243-3056
(631) 243-3132
Mailing address
435 BROOK AVE, UNIT 29, DEER PARK, NY 11729-6829
(631) 243-3056
(631) 243-3132
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
01467110
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01467110
—
NY
Enumeration date
01/18/2007
Last updated
08/22/2020
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