Provider Demographics
NPI:1437499662
Name:ROBERTA PRAVDER INC
Entity type:Organization
Organization Name:ROBERTA PRAVDER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRAVDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-698-2839
Mailing Address - Street 1:50 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1936
Mailing Address - Country:US
Mailing Address - Phone:516-487-9605
Mailing Address - Fax:516-829-6417
Practice Address - Street 1:50 CEDAR DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1936
Practice Address - Country:US
Practice Address - Phone:516-487-9605
Practice Address - Fax:516-829-6417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040420829252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency