Provider Demographics
NPI:1861766123
Name:EPPS THERAPEUTIC PARTNERS CO.
Entity type:Organization
Organization Name:EPPS THERAPEUTIC PARTNERS CO.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EPPS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R, BCD
Authorized Official - Phone:631-435-0421
Mailing Address - Street 1:149 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4100
Mailing Address - Country:US
Mailing Address - Phone:631-435-0421
Mailing Address - Fax:631-435-0421
Practice Address - Street 1:149 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4100
Practice Address - Country:US
Practice Address - Phone:631-435-0421
Practice Address - Fax:631-435-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033117302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN6J791OtherMEDICARE PROVIDER NUMBER
NYN6J791Medicare UPIN