Organization
VIVID IMAGINATION STATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRENA BILOUS (SPECIAL EDUCATION)
(718) 730-4442
Entity
Organization
Contact information
Practice address
216 JUSTIN AVE, STATEN ISLAND, NY 10306-3744
(718) 730-4442
Mailing address
216 JUSTIN AVE, STATEN ISLAND, NY 10306-3744
(718) 730-4442
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
06/28/2024
Last updated
07/01/2024
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