Provider Demographics
NPI:1629723804
Name:COACH VERA'S SLOW & STEADY HEALTH PROGRAM
Entity Type:Organization
Organization Name:COACH VERA'S SLOW & STEADY HEALTH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CDC NDPP LIFESTYLE COACH
Authorized Official - Prefix:MS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-813-5945
Mailing Address - Street 1:273 MAPLE PKWY # 2
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2464
Mailing Address - Country:US
Mailing Address - Phone:718-813-5945
Mailing Address - Fax:
Practice Address - Street 1:80 UNION AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2426
Practice Address - Country:US
Practice Address - Phone:718-813-5945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1649819889Medicaid
NY1881320455Medicaid
NY1982030698Medicaid
NY1437524568Medicaid