Provider Demographics
NPI:1043573413
Name:MANIFESTING DREAMS INC
Entity Type:Organization
Organization Name:MANIFESTING DREAMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENDUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MS EDDHH
Authorized Official - Phone:516-632-5562
Mailing Address - Street 1:335 PINE ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3141
Mailing Address - Country:US
Mailing Address - Phone:516-632-5562
Mailing Address - Fax:
Practice Address - Street 1:335 PINE ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3141
Practice Address - Country:US
Practice Address - Phone:516-632-5562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty