Provider Demographics
NPI:1063126373
Name:BE PROACTIVE INC
Entity type:Organization
Organization Name:BE PROACTIVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARABOLLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-233-1717
Mailing Address - Street 1:11035 72ND DR APT 2R
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5518
Mailing Address - Country:US
Mailing Address - Phone:347-233-1717
Mailing Address - Fax:
Practice Address - Street 1:11035 72ND DR APT 2R
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5518
Practice Address - Country:US
Practice Address - Phone:347-233-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service