Provider Demographics
NPI:1346517653
Name:PM EVALUATION & THERAPY SERVICES
Entity Type:Organization
Organization Name:PM EVALUATION & THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSONZA
Authorized Official - Suffix:
Authorized Official - Credentials:MSSPED
Authorized Official - Phone:631-332-8736
Mailing Address - Street 1:172 TREE AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3546
Mailing Address - Country:US
Mailing Address - Phone:631-332-8736
Mailing Address - Fax:631-539-2826
Practice Address - Street 1:172 TREE AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-3546
Practice Address - Country:US
Practice Address - Phone:361-332-8736
Practice Address - Fax:631-539-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY703380252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency