NPI 1184025058

Constractor

Organisation Exclusive Provider Organization Valley Stream, NY

Practice location

Address: 3 Georgia St, Valley Stream, NY 11580-2224
Phone: (347) 962-2006
Mailing address: PO Box 82, Valley Stream, NY 11582-0082

Authorised official

Name: Guerline D Gomez
Title: Special Education Teacher
Phone: (347) 962-2006

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 824950 (NY)

Other Exclusive Provider Organization providers in New York →

Registry record

NPI: 1184025058
Entity type: Organization
NPI issued: 10 Sep 2014
Record last updated: 10 Sep 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.