Individual
SIVAN ELIAZAROV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1434 E 19TH ST, BROOKLYN, NY 11230-6716
(717) 755-3218
Mailing address
10849 70TH AVE, FOREST HILLS, NY 11375-4349
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
020560-1
NY
Other
Enumeration date
05/17/2016
Last updated
05/17/2016
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