Provider Demographics
NPI:1518731157
Name:AMAZING GREAT BEAUTY OF SCIENCE
Entity type:Organization
Organization Name:AMAZING GREAT BEAUTY OF SCIENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY RESERCH DIRECTOR/SPECIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-504-3291
Mailing Address - Street 1:2701 MARION AVENUE
Mailing Address - Street 2:E6
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-8801
Mailing Address - Country:US
Mailing Address - Phone:646-609-0727
Mailing Address - Fax:
Practice Address - Street 1:2701 MARION AVENUE
Practice Address - Street 2:SUITE E6
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1210
Practice Address - Country:US
Practice Address - Phone:310-776-5991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No332U00000XSuppliersHome Delivered Meals
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty