Organization
IFE LANDSMARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE FALES (OFFICE MANAGER)
(631) 647-9011
Entity
Organization
Contact information
Practice address
NEW BROADVIEW MANOR - 70 FATHER CAPODANNO BLVD, STATEN ISLAND, NY 10305
(718) 273-8900
Mailing address
260 MONTAUK HWY, SUITE 8, BAY SHORE, NY 11706-8322
(631) 647-9011
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
008096-1
NY
Other
Enumeration date
11/17/2015
Last updated
11/17/2015
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