Provider Demographics
NPI:1598432064
Name:MAGNIFICENT MUNCHKINS LLC
Entity Type:Organization
Organization Name:MAGNIFICENT MUNCHKINS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-268-0798
Mailing Address - Street 1:645 ROSSVILLE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1795
Mailing Address - Country:US
Mailing Address - Phone:908-268-0798
Mailing Address - Fax:
Practice Address - Street 1:645 ROSSVILLE AVE STE 3
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-1795
Practice Address - Country:US
Practice Address - Phone:908-268-0798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty