Individual
MISS MAXINE ROSEMARIE HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
220-08 109 AVENUE, QUEENS VILLAGE, NY 11429
(917) 226-7249
Mailing address
22008 109TH AVE, QUEENS VILLAGE, NY 11429-2515
(917) 226-7249
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
460234-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TF7175290
NPI
NY
Enumeration date
05/16/2012
Last updated
05/16/2012
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