Organization
FUNCTIONAL LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELENA RAFAELOV (SPECIAL EDUCATION TEACHER)
(917) 412-7796
Entity
Organization
Contact information
Practice address
8110 135TH ST APT 201, JAMAICA, NY 11435-1041
(917) 412-7796
Mailing address
8110 135TH ST APT 201, JAMAICA, NY 11435-1041
(917) 412-7796
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NY
Other
Enumeration date
07/09/2012
Last updated
07/09/2012
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