Provider Demographics
NPI:1417612755
Name:PARENT INFORMATION EXCHANGE
Entity Type:Organization
Organization Name:PARENT INFORMATION EXCHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMRELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-344-0378
Mailing Address - Street 1:1040 OWASCO RD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-4221
Mailing Address - Country:US
Mailing Address - Phone:516-425-1905
Mailing Address - Fax:
Practice Address - Street 1:1040 OWASCO RD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-4221
Practice Address - Country:US
Practice Address - Phone:516-425-1905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty