Provider Demographics
NPI:1215427232
Name:HIMELSTEIN, EPHRAIM SOLOMON (MS SPED)
Entity type:Individual
Prefix:
First Name:EPHRAIM
Middle Name:SOLOMON
Last Name:HIMELSTEIN
Suffix:
Gender:M
Credentials:MS SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2740
Mailing Address - Country:US
Mailing Address - Phone:646-593-5813
Mailing Address - Fax:
Practice Address - Street 1:383 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2740
Practice Address - Country:US
Practice Address - Phone:646-593-5813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY755441174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY755441OtherSPECIAL EDUCATION TEACHING LICENSE