Provider Demographics
NPI:1558752477
Name:CHANA MIRIAM SIMON LLC
Entity Type:Organization
Organization Name:CHANA MIRIAM SIMON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:845-517-9221
Mailing Address - Street 1:127 ROCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5357
Mailing Address - Country:US
Mailing Address - Phone:845-517-9221
Mailing Address - Fax:845-356-5798
Practice Address - Street 1:127 ROCK HILL RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5357
Practice Address - Country:US
Practice Address - Phone:845-517-9221
Practice Address - Fax:845-356-5798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2129566252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency