Organization
VINE GATE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FUNKE CINDERELA AJIBOYE (EXECUTIVE DIRECTOR)
(917) 497-6791
Entity
Organization
Contact information
Practice address
42 AMITY PL, STATEN ISLAND, NY 10303
(917) 497-6791
Mailing address
85 HOLLAND AVENUE, APT 12L, STATEN ISLAND, NY 10303
(917) 497-6791
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
11/29/2017
Last updated
11/29/2017
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