Individual
MRS. JEANETTE RIVERA UY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5545 84TH ST, ELMHURST, NY 11373-4739
(718) 880-7857
Mailing address
5545 84TH ST, ELMHURST, NY 11373-4739
(718) 880-7857
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
784660
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930088244
GHI
NY
Enumeration date
10/05/2015
Last updated
10/05/2015
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