Provider Demographics
NPI:1841595527
Name:MAMA PROGRAM LLC
Entity Type:Organization
Organization Name:MAMA PROGRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANATOLIY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENYAMINOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-749-2068
Mailing Address - Street 1:11821 QUEENS BLVD STE 415
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7208
Mailing Address - Country:US
Mailing Address - Phone:917-749-2068
Mailing Address - Fax:718-989-3829
Practice Address - Street 1:11821 QUEENS BLVD STE 415
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7208
Practice Address - Country:US
Practice Address - Phone:917-749-2068
Practice Address - Fax:718-989-3829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)