Organization
214-18 HILLSIDE AVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACEMON KURIAKOSE (CEO)
(646) 331-7345
Entity
Organization
Contact information
Practice address
21418 HILLSIDE AVE, QUEENS VILLAGE, NY 11427-1808
(646) 331-7345
Mailing address
21418 HILLSIDE AVE, QUEENS VILLAGE, NY 11427-1808
(646) 331-7345
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
225100000X
Physical Therapist
—
—
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
—
—
225X00000X
Occupational Therapist
—
—
227800000X
Certified Respiratory Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
05/19/2013
Last updated
05/19/2013
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