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Organization

FAIRY LICEMOTHERS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CAROL MICHELLE GILBERT (PRESIDENT)
(516) 313-8095
Entity
Organization

Contact information

Practice address
2463 LONG BEACH RD, OCEANSIDE, NY 11572-1362
(866) 561-0492
Mailing address
2463 LONG BEACH RD, OCEANSIDE, NY 11572-1362
(866) 561-0492

Taxonomy

Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary

Other

Enumeration date
07/29/2017
Last updated
03/17/2018
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