Eyerosie LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

R205786 Issued in MD

Legal business name

EYEROSIE LLC

Practice address

4500 Forbes Blvd Ste 200
Lanham, MD 20706-6316

Phone

(443) 741-8920

Fax

(443) 203-2617

NPI assigned

Jun 11, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Siddiqui Hernandez

Title

Owner

Phone

(443) 741-8920

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1922537067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 FORBES BLVD STE 200",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207066316",
            "telephone_number": "443-741-8920",
            "fax_number": "443-203-2617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 FORBES BLVD STE 200",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207066316",
            "telephone_number": "443-741-8920",
            "fax_number": "443-203-2617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYEROSIE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-11",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "SIDDIQUI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-741-8920"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MD",
            "license": "R205786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "R205786",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Lanham, MD
• Providers in Lanham, MD by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.