Provider Demographics
NPI:1295964898
Name:ISRAELSHINING STAR INCORPORATED
Entity type:Organization
Organization Name:ISRAELSHINING STAR INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:PLEASANT
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:718-759-8495
Mailing Address - Street 1:PO BOX 900093
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11690-0093
Mailing Address - Country:US
Mailing Address - Phone:718-759-8594
Mailing Address - Fax:718-960-7437
Practice Address - Street 1:106-35 154TH STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-1917
Practice Address - Country:US
Practice Address - Phone:718-759-8594
Practice Address - Fax:718-960-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2205381251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health