Organization
GREHABCORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAYLE DJENABA JACKSON (OTR/L)
(516) 665-8935
Entity
Organization
Contact information
Practice address
725 MILLER AVE, FREEPORT, NY 11520-6350
(516) 991-6800
Mailing address
725 MILLER AVE, FREEPORT, NY 11520-6350
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
083831
NY
Other
Enumeration date
11/01/2008
Last updated
11/01/2008
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