Provider Demographics
NPI:1033543657
Name:SPACE EVENT. LLC
Entity Type:Organization
Organization Name:SPACE EVENT. LLC
Other - Org Name:SPACE E. LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NEKEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHAARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-419-4911
Mailing Address - Street 1:511 AVENUE OF THE AMERICAS
Mailing Address - Street 2:SUITE 721
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8436
Mailing Address - Country:US
Mailing Address - Phone:212-419-4911
Mailing Address - Fax:
Practice Address - Street 1:511 AVENUE OF THE AMERICAS
Practice Address - Street 2:SUITE 721
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8436
Practice Address - Country:US
Practice Address - Phone:212-419-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization