Provider Demographics
NPI:1407369812
Name:STRIDES TOWARD DEVELOPMENTAL MILESTONES
Entity Type:Organization
Organization Name:STRIDES TOWARD DEVELOPMENTAL MILESTONES
Other - Org Name:STDM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL EDUCATION TEACHER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:CASSANDRS
Authorized Official - Last Name:BOWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:347-944-9296
Mailing Address - Street 1:1238 G ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1425
Mailing Address - Country:US
Mailing Address - Phone:347-944-9296
Mailing Address - Fax:
Practice Address - Street 1:1238 G ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1425
Practice Address - Country:US
Practice Address - Phone:347-944-9296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty