Organization
CAMELOT OF SI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LUKE J NASTA (EXECUTIVE DIRECTOR)
(718) 816-6589
Entity
Organization
Contact information
Practice address
460 BRIELLE AVE, STATEN ISLAND, NY 10314-6427
(718) 816-6589
Mailing address
460 BRIELLE AVE, STATEN ISLAND, NY 10314-6427
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/26/2015
Last updated
03/26/2015
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