Provider Demographics
NPI:1629223086
Name:MIND-BODY AND INNER SELF
Entity Type:Organization
Organization Name:MIND-BODY AND INNER SELF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:917-658-9767
Mailing Address - Street 1:11929 80TH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1105
Mailing Address - Country:US
Mailing Address - Phone:718-362-0615
Mailing Address - Fax:
Practice Address - Street 1:11929 80TH RD
Practice Address - Street 2:SUITE A
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1105
Practice Address - Country:US
Practice Address - Phone:718-362-0615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization