| Interline Eap | |
|
14839 Hillside Ave Jamaica NY 11435-3330 | |
| (718) 206-1368 | |
| Not Available |
| Full Name | Interline Eap |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 14839 Hillside Ave, Jamaica, New York |
| Authorized Official Name and Position | Rosanne M Mirando (MEDICAL BILLER) |
| Authorized Official Contact | 7172061368 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Interline Eap 14839 Hillside Ave Jamaica NY 11435-3330 Ph: (718) 206-1368 | Interline Eap 14839 Hillside Ave Jamaica NY 11435-3330 Ph: (718) 206-1368 |
| NPI Number | 1003030644 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 10/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003030644 | NPI | - | NPPES |
| 01756972 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 01756972 (New York) | Primary |
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