Individual
CORNEILIA ESTREAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7000 AUSTIN ST STE 200, FOREST HILLS, NY 11375-4739
(718) 762-7633
Mailing address
1498 PUTNAM AVE, BROOKLYN, NY 11237-5911
(917) 652-1172
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
528773111
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2272649
TEACHER ID
NY
Enumeration date
03/18/2014
Last updated
03/18/2014
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