Organization
UBODR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORILYN M CORPUZ OTR (CEO)
(646) 552-8325
Entity
Organization
Contact information
Practice address
6136 64TH ST, MIDDLE VILLAGE, NY 11379-1023
(646) 552-8325
Mailing address
6136 64TH ST, MIDDLE VILLAGE, NY 11379-1023
(646) 552-8325
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
009256-1
NY
Other
Enumeration date
11/18/2010
Last updated
11/18/2010
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