Individual
JENIFFER MUNDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14550 222ND ST, SPRINGFIELD GARDENS, NY 11413-3428
(718) 598-5650
Mailing address
14550 222ND ST, SPRINGFIELD GARDENS, NY 11413-3428
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
932257193
GHI
—
Enumeration date
05/25/2016
Last updated
06/07/2016
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