Organization
PREVIT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH WOLFE MEDINA O.T. (PRESIDENT)
(347) 236-7847
Entity
Organization
Contact information
Practice address
64619TH ST., BROOKLYN, NY 11218
(347) 236-7847
(718) 686-2910
Mailing address
14 BOND ST, SUITE 430, GREAT NECK, NY 11021-2045
(347) 236-7847
(718) 686-2910
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
002031-1
NY
Other
Enumeration date
09/17/2010
Last updated
09/17/2010
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