Provider Demographics
NPI:1912256991
Name:UNIQUE PERFORMANCE
Entity type:Organization
Organization Name:UNIQUE PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COSMOTOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MURL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-264-1408
Mailing Address - Street 1:146 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2704
Mailing Address - Country:US
Mailing Address - Phone:631-264-1408
Mailing Address - Fax:631-264-1408
Practice Address - Street 1:146 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2704
Practice Address - Country:US
Practice Address - Phone:631-264-1408
Practice Address - Fax:631-264-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4792421744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty