Provider Demographics
NPI:1285193938
Name:MILES OF SMILES INC
Entity Type:Organization
Organization Name:MILES OF SMILES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YULIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROVA
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:718-593-9909
Mailing Address - Street 1:10 MERCER PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3431
Mailing Address - Country:US
Mailing Address - Phone:718-593-9909
Mailing Address - Fax:
Practice Address - Street 1:10 MERCER PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3431
Practice Address - Country:US
Practice Address - Phone:718-593-9909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency