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Organization
FAIRY LICEMOTHERS, LLC
Active
Organization
FAIRY LICEMOTHERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL MICHELLE GILBERT (PRESIDENT)
(516) 313-8095
Entity
Organization
Contact information
Practice address
2463 LONG BEACH RD, OCEANSIDE, NY 11572-1362
(866) 561-0492
Mailing address
2463 LONG BEACH RD, OCEANSIDE, NY 11572-1362
(866) 561-0492
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
NULL
Other
Enumeration date
07/29/2017
Last updated
03/17/2018
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