Provider Demographics
NPI:1922249283
Name:PROMED AGENCY
Entity Type:Organization
Organization Name:PROMED AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFFING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-719-9600
Mailing Address - Street 1:1943-76 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214
Mailing Address - Country:US
Mailing Address - Phone:718-331-0526
Mailing Address - Fax:
Practice Address - Street 1:18 EAST 41 STREET
Practice Address - Street 2:
Practice Address - City:NEWYORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-719-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency