Individual
EDA CHIONG GORDONCILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MRS.
Contact information
Practice address
17 GUERNSEY DR, NEW WINDSOR, NY 12553-8046
(845) 562-7283
Mailing address
17 GUERNSEY DR, NEW WINDSOR, NY 12553-8046
(845) 562-7283
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
011931-1
NY
Other
Enumeration date
04/13/2009
Last updated
04/13/2009
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