Provider Demographics
NPI:1003317017
Name:MESIDOR EARLY INTERVENTION LLC
Entity Type:Organization
Organization Name:MESIDOR EARLY INTERVENTION LLC
Other - Org Name:MICHELINE MESIDOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL INSTRUCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MESIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:347-410-3248
Mailing Address - Street 1:7916 147TH ST APT C8
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3766
Mailing Address - Country:US
Mailing Address - Phone:347-410-3248
Mailing Address - Fax:347-960-7625
Practice Address - Street 1:7916 147TH ST APT C8
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3766
Practice Address - Country:US
Practice Address - Phone:347-410-3248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-24
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328194252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherSPECIAL INSTRUCTION