Provider Demographics
NPI:1952029316
Name:AGARD, EMELDA
Entity Type:Individual
Prefix:
First Name:EMELDA
Middle Name:
Last Name:AGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:AGARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JEREMIAH SERVICES
Mailing Address - Street 1:24 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2922
Mailing Address - Country:US
Mailing Address - Phone:347-272-8867
Mailing Address - Fax:
Practice Address - Street 1:24 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2922
Practice Address - Country:US
Practice Address - Phone:347-272-8867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator