Organization
DIVINE PADILLA PT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIVINE GRACE PADILLA PT (PRESIDENT)
(718) 310-0892
Entity
Organization
Contact information
Practice address
1501 IMPERIAL AVE, NEW HYDE PARK, NY 11040-3945
(718) 310-0892
Mailing address
1501 IMPERIAL AVE, NEW HYDE PARK, NY 11040-3945
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
027946
NY
Other
Enumeration date
03/07/2012
Last updated
03/07/2012
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