Organization
SELF EMPLOYED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAITLYN SYMANCYK (REGISTERED NURSE)
(631) 235-8057
Entity
Organization
Contact information
Practice address
74 MILL DR, MASTIC BEACH, NY 11951-1403
(631) 599-8372
Mailing address
67 RADBURN DR, FARMINGVILLE, NY 11738-1046
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
705976-1
NY
Other
Enumeration date
11/09/2015
Last updated
11/09/2015
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