Provider Demographics
NPI:1770031189
Name:FLAMHOLTZ, P'NINA
Entity Type:Individual
Prefix:
First Name:P'NINA
Middle Name:
Last Name:FLAMHOLTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147-29 75TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3121
Mailing Address - Country:US
Mailing Address - Phone:305-761-6341
Mailing Address - Fax:
Practice Address - Street 1:147-29 75TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3121
Practice Address - Country:US
Practice Address - Phone:305-761-6341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008828-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency