Organization
LEGENDARY THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YOLIVETTE MEDINA (SERVICE COORDINATOR)
(718) 610-9454
Entity
Organization
Contact information
Practice address
1925 WILLIAMSBRIDGE RD, BRONX, NY 10461-1604
(718) 941-1900
Mailing address
660 SOUTHERN BLVD, 5D, BRONX, NY 10455-3653
(718) 610-9454
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
04/06/2015
Last updated
04/06/2015
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