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Organization
PRIVATE SELF CARE PROVIDER
Active
Organization
PRIVATE SELF CARE PROVIDER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNY P TELFORT (RN)
(347) 267-2991
Entity
Organization
Contact information
Practice address
53 5TH ST, VALLEY STREAM, NY 11581-1210
(347) 267-2991
Mailing address
53 5TH ST, VALLEY STREAM, NY 11581-1210
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
10/04/2012
Last updated
10/04/2012
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