Provider Demographics
NPI:1588904148
Name:EUGENIO MARIA DE HOSTOS
Entity type:Organization
Organization Name:EUGENIO MARIA DE HOSTOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SULAIH
Authorized Official - Middle Name:
Authorized Official - Last Name:PICORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-329-2733
Mailing Address - Street 1:4101 N AMERICAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2606
Mailing Address - Country:US
Mailing Address - Phone:215-329-2733
Mailing Address - Fax:
Practice Address - Street 1:6301 N 2ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1522
Practice Address - Country:US
Practice Address - Phone:215-329-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA126513100251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)