# DIVINE PADILLA PT PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578837654
- **Authorized official:** DIVINE GRACE PADILLA PT (PRESIDENT)
- **Authorized official phone:** (718) 310-0892

## Contact information

- **Practice address:** 1501 IMPERIAL AVE, NEW HYDE PARK, NY 11040-3945
- **Practice address phone:** (718) 310-0892
- **Mailing address:** 1501 IMPERIAL AVE, NEW HYDE PARK, NY 11040-3945

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | 027946 | NY | Yes |

## Other

- **Enumeration date:** 03/07/2012
- **Last updated:** 03/07/2012