Individual
MONSURAT MODUPE LADEJOBI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
225 BROADHOLLOW RD STE 402, MELVILLE, NY 11747-4899
(631) 385-7780
(631) 385-7795
Mailing address
7000 AUSTIN ST, FOREST HILLS, NY 11375-1022
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
09/07/2018
Last updated
09/20/2018
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